The risks of smoking while pregnant for each maternal and fetal health are well documented, but only about half of pregnant people quit smoking on their very own. To learn more about how e-cigarette or nicotine alternative therapy (NRT) influences smoking cessation later in pregnancy, University at Buffalo researchers compared abstinence rates within the two groups. They found that those using e-cigarettes before pregnancy were more more likely to abstain from smoking later in pregnancy.

Published in JAMA Network Open on Sept. 12, the research was conducted as an observational study of knowledge gathered from 1,329 pregnant people through the U.S. Pregnancy Risk Assessment Monitoring System (PRAMS) between 2016 and 2020.

It’s one in all the primary studies within the U.S. to deal with maternal e-cigarette use.

Addressing a research gap

There may be an urgent need for research on maternal e-cigarette use, as e-cigarettes have been increasingly utilized by young people, including pregnant individuals.”

Xiaozhong Wen, MD, PhD, corresponding writer and associate professor of pediatrics within the Jacobs School of Medicine and Biomedical Sciences at UB

As a researcher within the Division of Behavioral Medicine of the UB Department of Pediatrics, Wen has conducted multiple studies on smoking cessation while pregnant and postpartum.

“Our pregnant patients need to know more concerning the pros and cons of using e-cigarettes in comparison with cigarettes. Nonetheless, we do not know that much about e-cigarette use while pregnant, a considerable research gap,” he says.

The study found that among the many 1,329 respondents who had used either e-cigarettes or NRT (a patch, gum, lozenge, etc.) in pregnancy, about half (50.8%) of those that used e-cigarettes reported abstinence later in pregnancy versus 19.4% of those that were using some type of nicotine alternative therapy.

“In our evaluation of subpopulations within the study, we found that individuals who began using e-cigarettes before pregnancy had a fair higher smoking abstinence rate (53.1%) but that those that began using e-cigarettes during their pregnancy had an analogous smoking abstinence rate (20.6%) in comparison with NRT users (19.4%),” says Wen.

While the explanations for the discrepancy are unknown, Wen hypothesizes that there are a number of possibilities which may explain the difference.

“It’s possible that existing e-cigarette users, meaning those that had began using prior to becoming pregnant, had had positive experiences with these products after an initial adjustment period,” he explains. “It’s possible that using e-cigarettes allows patients to take care of smoking-related physical motions, psychological satisfaction, social behaviors and interactions with other smokers.”

He adds that e-cigarettes don’t typically have the unwanted effects (nausea, vomiting, sleep problems and headaches) that will affect those using nicotine alternative therapy.

Findings should be confirmed

Asked if the outcomes indicate that pregnant people attempting to quit smoking should consider e-cigarettes, Wen emphasizes that the findings from the study should be interpreted cautiously and should be confirmed in future randomized, controlled trials.

“The associations we have now identified between use of e-cigarettes and abstinence while pregnant won’t be causal,” he says, “especially given substantial confounding aspects, equivalent to smoking intensity.”

He refers back to the paper, which states, “If cigarette smokers prefer to not pursue NRT or have negative experiences and low adherence to NRT use, e-cigarettes could possibly be offered instead smoking cessation aid after a discussion of the potential harms and advantages of using e-cigarettes while pregnant compared with NRT or continued use of cigarettes.”

Wen’s multidisciplinary team of co-authors includes Minseon V. Chung and Wenxin Zhang, students in UB’s School of Pharmacy and Pharmaceutical Sciences; Kayla A. Liszewski of the UB School of Public Health and Health Professions; Lauren D. Todoro, a Jacobs School medical student; Eve M. Giancarlo, a student researcher within the UB Department of Pediatrics; Sara K. Berkelhamer, MD, of the University of Washington; and Maciej L. Goniewicz of Roswell Park Comprehensive Cancer Center.

The study was supported by grants from the National Institute on Drug Abuse and the National Institutes of Health.

Source:

Journal reference:

Wen, X., et al. (2023). Cigarette Smoking Abstinence Amongst Pregnant Individuals Using E-Cigarettes or Nicotine Substitute Therapy. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2023.30249.