Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Nov 18;24(1):3200.
doi: 10.1186/s12889-024-20746-9.

Prevalence of dual use of combustible tobacco and E-cigarettes among pregnant smokers: a systematic review and meta-analysis

Ganesh Bushi #  1   2 , Mahalaqua Nazli Khatib #  3 , Ashok Kumar Balaraman  2 , Suhas Ballal  4 , Pooja Bansal  5 , Balvir S Tomar  6 , Ayash Ashraf  7 , M Ravi Kumar  8 , Aashna Sinha  9 , Pramod Rawat  10 , Abhay M Gaidhane  11 , Sanjit Sah  12   13   14 , Rukshar Syed  15 , Gajendra Sharma  16 , Rachana Mehta  17   18 , Mona Thangamma A G  19 , Nagavalli Chilakam  20 , Sakshi Pandey  21 , Manvinder Brar  22 , Muhammed Shabil  23   24
Affiliations
Meta-Analysis

Prevalence of dual use of combustible tobacco and E-cigarettes among pregnant smokers: a systematic review and meta-analysis

Ganesh Bushi et al. BMC Public Health. .

Abstract

Background: As e-cigarettes gain popularity as potential tobacco cessation aids, concerns arise about their dual use with traditional cigarettes, especially among pregnant women, potentially subjecting both women and fetuses to heightened risks. This systematic review and meta-analysis aimed to determine the overall prevalence of dual use of tobacco smoking and e-cigarette use in pregnant women.

Methods: A literature search was conducted across databases including PubMed, Embase, Web of Science, and Cochrane on October 20, 2023. The included studies reported the number of pregnant women and the count of those who were dual users. Quality assessment was undertaken using the JBI tool. The pooled prevalence of dual use was determined via a random-effects model. All statistical analyses were executed using R software, version 4.3.

Prospero: CRD42023486020.

Results: Eighteen studies were analyzed, encompassing 5,983,363 pregnant women. The meta-analysis indicated an overall prevalence of 4.6% (95% CI: 2.0-10.3) for dual users with significant heterogeneity (I2 = 100%). Subgroup analysis based on the country showed a prevalence of 4.9% (95% CI: 2.0 to 11.6) for USA and 8.1% (95% CI: 0.00 to 1.00) for UK. Meta-regression revealed reduction of prevalence of dual use from 2019 to 2023. A potential publication bias was indicated by the LFK index and the Doi plot.

Conclusion: The dual consumption of e-cigarettes and traditional tobacco in pregnant women is a significant health concern, with a notable prevalence. Given the established risks of tobacco smoking during pregnancy and the uncertainties surrounding e-cigarettes, more comprehensive research and public health interventions are urgently needed to address this issue.

Keywords: Dual-use; E-cigarette; Meta-analysis; Pregnancy; Systematic review; Tobacco.

PubMed Disclaimer

Conflict of interest statement

Declarations Ethical approval Not required. Consent to publish Not applicable. Competing interests The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram depicting the screening and selection of studies
Fig. 2
Fig. 2
Forest plot showing the pooled prevalence of dual users during pregnancy. Red squares: The size of the square represents the weight of the study in the meta-analysis, with larger squares indicating a greater weight. The point estimate of the effect size (proportion of dual users) for each study is at the center of the square. Horizontal Lines: These represent the 95% CI for each study’s effect size. A wider line suggests a less precise estimate. Diamond: Represents the pooled effect size estimate and its 95% CI
Fig. 3
Fig. 3
Forest plot depicting the country wise pooled prevalence
Fig. 4
Fig. 4
Bubble plot illustrating the results of meta-regression based on year of publication
Fig. 5
Fig. 5
Doi plot represents the publication bias of the studies included
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Huerta TR, Walker DM, Mullen D, Johnson TJ, Ford EW. Trends in e-cigarette awareness and perceived harmfulness in the US. Am J Prev Med. 2017;52(3):339–46. - PubMed
    1. Pericot-Valverde I, Gaalema DE, Priest JS, Higgins ST. E-cigarette awareness, perceived harmfulness, and ever use among US adults. Prev Med. 2017;104:92–9. - PMC - PubMed
    1. Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. Lancet Respiratory Med. 2016;4(2):116–28. - PMC - PubMed
    1. McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction. Cochrane Database Syst Reviews. 2014(12). - PubMed
    1. Hartmann-Boyce J, Lindson N, Butler AR, McRobbie H, Bullen C, Begh R et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Reviews. 2022(11). - PMC - PubMed