Use of electronic nicotine delivery systems by pregnant women II: Hair biomarkers for exposures to nicotine and tobacco-specific nitrosamines
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Department of Environmental and Occupational Health, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, United States
Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, United States
Department of Biostatistics, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, United States
Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, United States
Department of Community Health, University of Uyo, Uyo, Nigeria
Lori A. Fischbach   

Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham, AR 72205, Little Rock, Arkansas, United States
Publish date: 2019-06-06
Tob. Induc. Dis. 2019;17(June):50
Public awareness of electronic nicotine delivery systems (ENDS) has increased over time, and the perception that ENDS offer a safer alternative to cigarettes may lead some pregnant women to use them to reduce cigarette smoking during pregnancy. No previous studies have used metabolite levels in hair to measure nicotine exposure for ENDS users during pregnancy. We aimed to measure and compare levels of nicotine, cotinine, and tobacco-specific nitrosamines (TSNAs) in hair samples from pregnant women who were current ENDS users, current smokers, and current non-smokers. We also aimed to estimate the association between ENDS use/smoking and smallness for gestational age (SGA).

We used hair specimens from pregnant women who were dual users (ENDS and cigarettes), smokers, and non-smokers from a prospective cohort study to estimate exposure to nicotine, cotinine, and TSNAs. The exposure biomarkers and self-reports of smoking and ENDS use were used in log-binomial regression models to estimate risk ratios (RRs) for SGA among offspring.

Nicotine concentrations for pregnant dual users were not significantly different from those for smokers (11.0 and 10.6 ng/mg hair, respectively; p=0.58). Similarly, levels of cotinine, and TSNAs for pregnant dual users were not lower than those for smokers. The RR for SGA was similar for dual users and smokers relative to nonsmokers, (RR=3.5, 95% CI: 0.8–14.8) and (RR=3.3, 95% CI: 0.9– 11.6), respectively. Using self-reports confirmed by hair nicotine, the RR values for dual ENDS users and smokers were 8.3 (95% CI: 1.0–69.1) and 7.3 (95% CI:1.0–59.0), respectively.

We did not observe lower levels of nicotine, cotinine, and TSNAs for current dual users compared to smokers during pregnancy. The risk of SGA for offspring of pregnant dual users was similar to that for offspring of pregnant smokers. Future studies are needed to further estimate the magnitude of the association between ENDS use and smallness for gestational age.

The authors declare that they have no competing interests, financial or otherwise, related to the current work. U. Ekanem reports grants from Arkansas Department of Health, personal fees from University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health, grants from National Institutes of Health (NIH) - National Center for Research Resources and National Center for Advancing Translational Sciences, during the conduct of the study. The rest of the authors have also completed and submitted an ICMJE form for disclosure of potential conflicts of interest.
This work was supported in part, by grant funds from the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) program (UL1TR000039 and KL2TR000063) and from the Arkansas Department of Health to the University of Arkansas at Pine Bluff Minority Research Center on Tobacco and Addictions. In addition, the work received support from the Arkansas Bioscience Institute and the Envoys, an advocacy group of the UAMS Cancer Institute Foundation.
Not commissioned; externally peer reviewed.
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