RESEARCH PAPER
Use of Electronic Nicotine Delivery Systems (ENDS) by pregnant women I: Risk of small-for-gestational-age birth
 
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1
Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, United States
2
The Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, United States
3
Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, United States
4
Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, United States
5
Department of Community Health, Faculty of Clinical Sciences, University of Uyo, Uyo, Nigeria
6
Arkansas Department of Health, Little Rock, United States
CORRESPONDING AUTHOR
Victor M. Cardenas   

Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, United States
Publish date: 2019-05-21
 
Tob. Induc. Dis. 2019;17(May):44
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The 2016 US Surgeon General’s Report suggests that the use of electronic nicotine delivery systems (ENDS) is a fetal risk factor. However, no previous study has estimated their effect on adverse pregnancy outcomes. We assessed the prevalence of current ENDS use in pregnant women and explored the effect on birth weight and smallness-for-gestational-age (SGA), correcting for misclassification from nondisclosure of smoking status.

Methods:
We conducted a cohort study with 248 pregnant women using questionnaire data and biomarkers (salivary cotinine, exhaled carbon monoxide, and hair nicotine). We evaluated the association between birth weight and the risk of SGA by applying multivariate linear and log-binomial regression to reproductive outcome data for 232 participants. Participants who did not disclose their smoking status were excluded from the referent group. Sensitivity analysis corrected for misclassification of smoking/ENDS use status.

Results:
The prevalence of current ENDS use among pregnant women was 6.8% (95% CI: 4.4–10.2%); most of these (75%) were concurrent smokers. Using self-reports, the estimated risk ratio of SGA for ENDS users was nearly two times the risk in the unexposed (RR=1.9, 95% CI: 0.6–5.5), and over three times that for ENDS-only users versus the unexposed (RR=3.1, 95% CI: 0.8–11.7). Excluding from the referent group smokers who did not disclose their smoking status, the risk of SGA for ENDS-only use was 5 times the risk in the unexposed (RR=5.1, 95% CI: 1.1– 22.2), and almost four times for all types of ENDS users (RR=3.8, 95% CI: 1.3–11.2). SGA risk ratios for ENDS users, corrected for misclassification due to self-report, were 6.5–8.5 times that of the unexposed.

Conclusions:
Our data suggest that ENDS use is associated with an increased risk of SGA.

ACKNOWLEDGEMENTS
This work was supported in part by a grant from the Arkansas Department of Health (ADH) to the University of Arkansas at Pine Bluff Minority Research Center (MRC) on Tobacco and Addictions, sub-awarded to VM Cardenas. Funding available from the UAMS Fay W. Boozman College of Public Health for personal development to VM Cardenas and RR Delongchamp was also used to support part of the data collection. HL Moody, P Murphy and A Ward, from the SARA Study at the UAMS Department of Obstetrics and Gynecology, provided assistance with primary data collection and data abstraction. We were also supported by the UAMS Translational Research Institute (grant UL1TR000039) through the National Institutes of Health (NIH) National Center for Research Resources and National Center for Advancing Translational Sciences. We are very thankful to Howraa-Al Mousawi, Chief of the Vital Statistics Section at the ADH, and to other members of the ADH leadership for their support in obtaining birth records for participants who did not deliver their babies at UAMS. The manuscript content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, MRC, or ADH. We also acknowledge the support of past and current staff of the UAMS Women’s Clinic, JC Brothers, MK Robinson, P Ward, and S Eastham, for their support in data collection. We thank SL Thomas for her valuable assistance with the literature search. Finally, we thank the UAMS Science Communication Group for editing this manuscript.
CONFLICTS OF INTEREST
Authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
There was no source of funding for this research.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
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CITATIONS (1):
1.
Use of electronic nicotine delivery systems by pregnant women II: Hair biomarkers for exposures to nicotine and tobacco-specific nitrosamines
Melissa Clemens, Victor Cardenas, Lori Fischbach, Ruiqi Cen, Eric Siegel, Hari Eswaran, Uwemedimbuk Ekanem, Anuradha Policherla, Heather Moody, Everett Magann, Gunnar Boysen
Tobacco Induced Diseases
 
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