Exposures and Health Risk Associated with Electronic cigarette use during Pregnancy - Abstract: Electronic cigarettes (e-cigarettes/vapes) have exploded in popularity over the past several years with approximately 11.1 million (2021) U.S. adults and 2.13 million (2023) U.S. youths using e-cigarettes. Of particular concern has been the meteoric rise in the prevalence of vaping amongst pregnant women, where the prevalence ranges from 3 – 15%. Pregnant women may be at greater risk for vaping due to their perceived safety and may be more vulnerable to the risks due to the physiological and hormonal changes they undergo during pregnancy and fetal exposure. Despite the rise in prevalence and increased risk there is currently a paucity of research on the health effects of vaping during pregnancy. Limited prior studies on the topic have linked exclusive vaping during pregnancy with adverse birth outcomes such as lower birth weight and being small for gestational age; however, findings remain mixed. Prior studies on the topic have been limited by a lack of data on exposures and inflammation. Furthermore, most studies that have investigated the effects of vaping during pregnancy have been comparative studies with combustible cigarette use during pregnancy. Therefore, this study aims to investigate the health effects of exclusive vaping during pregnancy and determine the prevalence and characteristics of exclusive vaping during pregnancy in Birmingham, Alabama. To accomplish this, we will leverage the infrastructure and resources available through the University of Alabama at Birmingham (UAB) Hospital and Center for Women’s Reproductive Health. Participants recruited from UAB OB/GYN prenatal care clinics will self-report their tobacco product use during pregnancy via their standard hospital intake survey and the survey developed by our team. The results of these surveys will then be validated for 100 randomly recruited participants using urinary cotinine and exhaled carbon monoxide tests, which in combination will allow us to differentiate between vapers, smokers, and non-users. Data on the agreement between participants self-reported and biologically validated tobacco use will then be used to determine the prevalence of vaping during pregnancy in Birmingham, Alabama. We will then recruit a total of 120 pregnant participants to compare the exposure and inflammatory biomarker concentrations found in blood and urine, which will include (N=60) validated pregnant exclusive vapers and (N=60) validated pregnant non- users to determine whether pregnant vapers have significantly elevated levels of e-cigarette specific exposure and inflammatory biomarkers. Finally, exposure and inflammatory biomarker concentrations found in the umbilical cord blood of a subset of the pregnant vapers (N=20) and pregnant non-users (N=20) will be compared to see if maternal vaping related chemicals can make their way into fetal circulation and if they are elevated in e-cigarette users. This study will fill important current knowledge gaps on the health effects of vaping during pregnancy and will provide strong evidence which physicians and policy makers can use to make informed decisions.
