妊娠前に電子タバコを使用していた人は、ニコチン置換療法を使用していた人よりも禁煙する可能性が高かった(People who used e-cigarettes before pregnancy were more likely to stop smoking than those using nicotine replacement therapy)

2023-09-12 バッファロー大学(UB)

<関連情報>

• https://www.buffalo.edu/news/releases/2023/09/E-cigarettes-in-pregnancy-led-to-smoking-abstinence.html
• https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809199

電子タバコまたはニコチン置換療法を使用している妊娠中の人のタバコ禁煙 Cigarette Smoking Abstinence Among Pregnant Individuals Using E-Cigarettes or Nicotine Replacement Therapy

Xiaozhong Wen, Minseon V. Chung, Kayla A. Liszewski, Lauren D. Todoro, Eve M. Giancarlo, Wenxin Zhang, Sara K. Berkelhamer, Maciej L. Goniewicz
JAMA Network Open  Published:September 12, 2023
DOI:10.1001/jamanetworkopen.2023.30249

Key Points

Question What is the association of electronic cigarette (e-cigarette) use vs nicotine replacement therapy (NRT) with smoking abstinence among US pregnant individuals who smoke combustible cigarettes?

Findings In this cohort study of 1329 pregnant individuals in the US who smoked cigarettes before pregnancy, use of e-cigarettes during pregnancy was associated with a higher rate of cigarette smoking abstinence in late pregnancy compared with use of NRT. Stratified by the timing of e-cigarette use initiation, the smoking abstinence rate was higher among individuals who initiated e-cigarette use before pregnancy than NRT users, but individuals who initiated e-cigarette use during pregnancy had a similar smoking abstinence rate to NRT users.

Meaning These findings suggest that e-cigarettes have the potential to be a smoking cessation aid for pregnant individuals, especially if they initiate their use before pregnancy, indicating that replacement of cigarettes with e-cigarettes during pregnancy may also represent a strategy for harm reduction.

Abstract

Importance Smoking cigarettes during pregnancy can impair maternal and child health, and pregnant individuals have increasingly used electronic cigarettes (e-cigarettes) for various reasons, including quitting smoking.

Objective To assess smoking abstinence rates among pregnant individuals who used e-cigarettes compared with those who used nicotine replacement therapy (NRT).

Design, Setting, and Participants This cohort study is a secondary data analysis of phase 8 of the US Pregnancy Risk Assessment Monitoring System, conducted between 2016 and 2020. Eligible participants included pregnant individuals who smoked combustible cigarettes within the 3 months before pregnancy and either used e-cigarettes or NRT during pregnancy. Data analysis was conducted from March 2022 to April 2023.

Exposures Combustible cigarette use within 3 months before pregnancy and use of either e-cigarettes or NRT during pregnancy.

Main Outcomes and Measures The primary outcome was the individual’s self-reported smoking abstinence status during the last 3 months of pregnancy. Weighted percentages were reported and weighted multivariable logistic regression models were used to examine the association of e-cigarette use vs NRT with smoking abstinence. A propensity score was used to control for confounding by sociodemographics, pregnancy characteristics, prepregnancy smoking intensity, depression, behavioral support, and hookah use.

Results The cohort included 1329 pregnant individuals (759 ≥25 years [60.2%]; 766 non-Hispanic White individuals [79.8%]) of whom 781 had an education level of high school or lower (61.4%), and 952 had an annual household income of $48 000 or less (81.5%). Of the 1329 individuals, 890 (unweighted percentage, 67.0%) were existing e-cigarette users, 67 (unweighted percentage, 5.0%) were new e-cigarette users, and 372 (unweighted percentage, 28.0%) were NRT users. Compared with individuals who used NRT during pregnancy, individuals who used e-cigarettes had a higher rate of smoking abstinence in late pregnancy (456 individuals [50.8%] vs 67 individuals [19.4%]; propensity score adjusted odds ratio [OR], 2.47; 95% CI, 1.17-5.20; P = .02). In the secondary analysis stratified by the timing of e-cigarette use initiation, existing users of e-cigarettes who initiated before pregnancy had a higher smoking abstinence rate than NRT users (446 users [53.1%] vs 67 users [19.4%]; adjusted OR, 2.61; 95% CI, 1.23-5.51; P = .01). However, new e-cigarette users who initiated use during pregnancy had a similar smoking abstinence rate in late pregnancy when compared with NRT users (10 users [20.6%] vs 67 users [19.4%]; adjusted OR, 1.13; 95% CI, 0.22-5.87; P = .88).

Conclusions and Relevance These findings suggest that individuals who used e-cigarettes during pregnancy had a higher smoking abstinence rate in late pregnancy than individuals who used NRT, especially for those who initiated e-cigarette use before pregnancy, indicating that replacement of cigarettes with e-cigarettes during pregnancy may be a viable strategy for harm reduction.