How popular are e-cigarettes with pregnant women?

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While a great deal of research has been dedicated to understanding the maternal and fetal impact of tobacco exposure in pregnant women, data on the effects of e-cigarettes are sparse. A recent study in JAMA Pediatrics aimed to provide the first national estimate of e-cigarette use among pregnant and non-pregnant women of reproductive age.

The authors used representative data from the National Health Interview Survey (NHIS). Since 2014, NHIS participants have been asked questions about their lifetime use of e-cigarettes, as well as their lifetime and current use of conventional cigarettes. To estimate prevalence of ever and current use of e-cigarettes from 2014 to 2017, the authors applied survey weights to account for unequal probability of selection and nonresponse.

The study included 27,920 women aged 18 to 44 years (1,071 pregnant and 26,849 nonpregnant). The authors noted that the weighted prevalence of current conventional cigarette use was significantly lower among pregnant women (8.0% [standard error (SE) 2.4%]) than among nonpregnant women (14.3% [0.4%]); P = .01 for difference). The weighted prevalence (SE) of current e-cigarette use was not significantly different between pregnant women (3.6% [2.4%]) and nonpregnant women (3.3% [0.2%]; P = .92 for difference). 

In regard to e-cigarette usage among pregnant women, the weighted prevalence (SE) of current e-cigarette use was 38.9% (19.0%) for current conventional cigarette smokers, 1.3% (1.0%) among former smokers, and 0.3% (0.3%) among never smokers. The authors also found that of nonpregnant women, 13.5 (0.8%) who currently smoked conventional cigarettes also used e-cigarettes and  8.8% (1.0%) of former cigarette smokers and 0.7% (0.1%) of never smokers used the devices. 

Use of conventional cigarettes was significantly lower in pregnant women than in nonpregnant women, but use of e-cigarettes was almost identical between the two groups. The authors said that it is possible that some pregnant women perceive e-cigarettes as a safe alternative to conventional cigarettes. Further, some women who used conventional cigarettes may have switched to e-cigarettes in pregnancy to assist with smoking cessation. The authors believe their findings indicate the need for more studies focused on the changing patterns of e-cigarette and conventional cigarette use among pregnant women, especially as a means to inform policy.