Maternal vaping and pregnancy adverse outcomes: A systematic review and meta-analysis

Abstract

Background: The increasing use of vaping during pregnancy raises concerns due to known risks of nicotine exposure. This meta-analysis assesses the association between maternal vaping and preterm birth, low birth weight, and small-for-gestational-age, compared to non-smokers, tobacco smokers, and dual users (both vaping and combastible tobacco use).

Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed, Web of Science, and Cochrane Library were searched for studies published from Auguts 1986 to December 2024. Eligible studies included pregnant women using vaping, with reported outcomes on preterm birth, low birth weight, or small-for-gestational-age. Odds ratios (ORs) with 95 % confidence intervals (CIs) were pooled using fixed- or random-effects models.

Results: Nine studies involving 423,680 pregnant women met the inclusion criteria. Compared to non-smokers, vaping use was associated with a 40 % increased risk of preterm birth (OR = 1.40, 95 % CI: 1.25-1.58), a 49 % increased risk of low birth weight (OR = 1.49, 95 % CI: 1.32-1.69), and a 32 % increased risk of small-for-gestational-age (OR = 1.32, 95 % CI: 1.17-1.48). No significant difference was found between vaping users and smokers or dual users for preterm birth or low birth weight. However, vaping users had a 47 % lower risk of small-for-gestational-age (OR = 0.53, 95 % CI: 0.42-0.66), and a 67 % lower risk compared to dual users (OR = 0.33, 95 % CI: 0.18-0.61).

Conclusion: Vaping during pregnancy is associated with a significantly higher risk of preterm birth, low birth weight, and small-for-gestational-age, compared to non-use of nicotine.

Keywords: Electronic cigarettes; Low birth weight; Pregnancy; Prenatal care; Preterm birth; Small-for-gestational-age; Vaping, tobacco smoking.