717: Prenatal electronic cigarette, dual use and nicotine dependency

Abstract

Prenatal tobacco use increases risk for nearly all adverse prenatal outcomes. Use of electronic cigarettes (ECIGS) has markedly increased with the perception that they are a safer alternative and may assist with smoking cessation. We previously reported nearly all pregnant women that use ECIGS also simultaneously use conventional cigarettes (dual users). The objective of this study was to identify patterns and predictors of prenatal dual cigarette use. An analysis of an ongoing, prospective multicenter trial using quota sampling was used. Pregnant women in their first trimester, aged 18-44, who currently used conventional cigarettes, ECIGS, or both (dual users) were included. Tobacco use categories were confirmed using preset cotinine limits and maternal self-report. Validated tools were used to measure nicotine dependence (Fagerstrom Test for Nicotine Dependence), expired air carbon monoxide (EACO) levels (Bedford) and depressive symptoms (Edinburgh Postnatal Depressions Scale, EDPS). Data analysis included descriptive statistics, univariate and multivariate analysis predicting the likelihood of nicotine dependence in pregnancy. All statistical analyses were performed using SAS v9.4 with an alpha of 0.05. Total sample included 117 women (dual, n=27; convention-only, n=90). EACO levels and number of cigarettes per day were similar between conventional and dual users. Prenatal dual use and increased depressive symptoms were significantly predictive of higher dependence (p=007). Controlling for age, race and education, dual users had an average of 1-point higher on the Fagerstrom index (beta=0.93; p=.034) with a range of 0-10, compared to conventional cigarette-only users. Every 5-point increase (range, 0-30) in depressive symptoms was associated with a 0.5 point increase in nicotine dependence (p=.019). Age, race and education were not associated with dependence in this sample. Pregnant dual users smoke similar amounts of cigarettes per day and have comparable EACO levels to conventional users, though exhibit higher levels of nicotine dependency, indicating ECIGS may not be effective smoking cessation aids during pregnancy. Further research is warranted to determine the effect of ECIGS on birth outcomes.