Preconception vaping, alcohol use not linked to spontaneous abortion risk

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Preconception behaviors including alcohol consumption and nicotine vaping are not significantly associated with increased risk of spontaneous abortion, according to findings from new research.

In new data presented at the American Urological Association (AUA) 2024 Annual Meeting in San Antonio, TX, this week, a team of US-based investigators reported that neither vaping nor alcohol use among men and/or women prior to conception are linked to spontaneous abortion risk. The collective findings from the 2 analyses of the North American-based Pregnancy Study Online (PRESTO) preconception cohort trial contribute to the limited evidence considering the reproductive health-related effect of either behavior.

The investigators sought to evaluate the individual associations between vaping and alcohol consumption in male and female partners preconception, and risk of spontaneous abortion. In both instances in their analysis of PRESTO data—a cohort analysis of couples planning pregnancy from 2013 – 2023—the team wanted to fulfill what they described as “minimal data” regarding either behavior’s impact on pregnancy loss.

Alcohol consumption

In the alcohol consumption analysis, investigators assessed PRESTO data that which included female participant and their male partners who each completed baseline questionnaires in the preconception period. Questionnaire data included demographic information, and lifestyle characteristics and behavior including alcohol consumption. The female participants were additionally required to complete bimonthly follow-up questionnaires for 12 months regarding their pregnancy status.¹

Investigators analyzed data from 9414 female participants, as well as 2613 couples where both partners provided complete data on alcohol consumption. Alcohol consumption was categorized into 4 categories: none; light (1 – 7 drinks per week); moderate (8 – 14/week); and heavy (≥14/week).

The team estimated hazard ratios (HRs) and 95% confidence intervals (Cis) to define association between preconception alcohol consumption and spontaneous abortion, with adjustments made for demographic and lifestyle factors.

Mean patient age among males was 32 years old, and 30 years old among females. A majority (86%) of participants identified as White. Among the full cohort, 60% of females reported light drinking; another 11% reported moderate drinking, and 3% reported heavy drinking. Among the couple-based cohort, half (49%) of males reported light drinking; 20% reported moderate drinking, and 12% reported heavy drinking.

Spontaneous abortions occurred in 1 in every 5 pregnancies in both the couple-based cohort (22%) and the full cohort (21%).

Investigators observed no significant link between male partner drinking and spontaneous abortion versus no drinking in the partners cohort:

• Light drinking (HR, 0.98; 95% CI, 0.77 – 1.25)
• Moderate drinking (HR, 0.95; 95% CI, 0.70 – 1.28)
• Heavy drinking (HR, 0.94; 95% CI, 0.67 – 1.31)

In the full cohort, investigators observed no significant risk of spontaneous abortion among women with moderate (HR, 0.97; 95% CI, 0.83 – 1.13) and heavy (HR, 0.86; 95% CI, 0.64 – 1.15) habits versus women who did not drink. In fact, women who reported light drinking during preconception were found to have a lowered risk of spontaneous abortion than those who did not drink (HR, 0.88; 95% CI, 0.79 – 0.98).

“Further stratification by female partner age did not show meaningful evidence of effect modification on the association between alcohol consumption and spontaneous abortion in the couple-based cohort,” investigators wrote. “Preconception alcohol consumption by either partner was not meaningfully associated with incidence of spontaneous abortion.”

Vaping

In the vaping assessment, investigators again analyzed PRESTO data from 2013 – 2023, stratified by full female and partners cohorts, to observe any association between the lifestyle behavior and risk of spontaneous abortion. The team compared preconception vaping and other tobacco use to non-use.²

Their data included 6136 female participants and 1668 couples in each cohort with available questionnaire responses regarding vaping use. Again, HRs and 95% CIs were estimated to define association between vaping and spontaneous abortion incidence, with adjustment for demographic and lifestyle factors.

Similarly to the alcohol cohorts, mean male age was 32 years old, mean female age was 30 years old, and 85% of participants identified as White. In the full cohort, 13% of females reported current vaping, 3% reported current cigarette smoking, and 11% reported former smoking at baseline. In the couples cohort, 19% of males currently vaped.

Investigators observed 22% of pregnancies ending in spontaneous abortion in the full cohort, as 24% in the couples cohort. They reported no significant association between current male vaping and spontaneous abortion incidence (HR, 0.95; 95% CI, 0.72 – 1.26). Female vaping was associated with an increased risk of spontaneous abortion—although the link was statistically insignificant (HR, 1.31; 95% CI, 0.61 – 2.79).

Among the full cohort, investigators observed insignificant associations between female vaping and smoking relative to non-use. A further analysis of female participants, upon stratifying based on finer definition of smoking status, additionally did not observe any meaningful link between tobacco use and spontaneous abortion risk.

“Nicotine vaping in either partner during the preconception period was not appreciably associated with spontaneous abortion incidence,” investigators concluded. “There was also little evidence that cigarette smoking modified the association between vaping and spontaneous abortion incidence."

References

1. ^{Scott M, Zhang CA, Eisenberg M, Wise L. MP13-12 A PRECONCEPTION COHORT STUDY OF ALCOHOL USE AND INCIDENCE OF SPONTANEOUS ABORTION. Journal of Urology. Published May 1, 2024. https://doi.org/10.1097/01.JU.0001008832.14212.d6.12}
2. ^{Scott M, Zhang CA, Wang T, Harlow AF, et al. MP13-11 A PRECONCEPTION COHORT STUDY OF NICOTINE VAPING AND INCIDENCE OF SPONTANEOUS ABORTION. Journal of Urology. Published May 1, 2024. https://doi.org/10.1097/01.JU.0001008832.14212.d6.11}