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

Bushi G 1 , Khatib MN 2 , Balaraman AK 3 , Ballal S 4 , Bansal P 5 , Tomar BS 6 Show all authors , Ashraf A 7 , Kumar MR 8 , Sinha A 9 , Rawat P 10 , Gaidhane AM 11 , Sah S 12 , Syed R 13 , Sharma G 14 , Mehta R 15 , A G MT 16 , Chilakam N 17 , Pandey S 18 , Brar M 19 , Shabil M 20

Affiliations 

  • 1 School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
  • 2 Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
  • 3 Research and Enterprise, University of Cyberjaya, Persiaran Bestari, Cyber 11, Cyberjaya, Selangor, 63000, Malaysia
  • 4 Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University), Bangalore, Karnataka, India
  • 5 Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, Rajasthan, 303012, India
  • 6 Institute of Pediatric Gastroenterology and Hepatology, NIMS University, Jaipur, India
  • 7 Chandigarh Pharmacy College, Chandigarh Group of College, Jhanjeri, Mohali, Punjab, 140307, India
  • 8 Department of Chemistry, Raghu Engineering College, Visakhapatnam, Andhra Pradesh, 531162, India
  • 9 School of Applied and Life Sciences, Division of Research and Innovation, Uttaranchal University, Dehradun, India
  • 10 Department of Biotechnology, Graphic Era (Deemed to be University), Clement Town, Dehradun, 248002, India
  • 11 Jawaharlal Nehru Medical College and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India. abhay.psm@dmiher.edu.in
  • 12 SR Sanjeevani Hospital, Kalyanpur, Siraha, 56517, Nepal. sanjitsahnepal561@gmail.com
  • 13 IES Institute of Pharmacy, IES University, Bhopal, Madhya Pradesh, 462044, India
  • 14 New Delhi Institute of Management, Delhi, India
  • 15 Clinical Microbiology, RDC, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, 121004, India
  • 16 Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
  • 17 Noida Institute of Engineering and Technology (Pharmacy Institute), Greater Noida, India
  • 18 Centre of Research Impact and Outcome, Chitkara University, Rajpura, Punjab, 140417, India
  • 19 Chitkara Centre for Research and Development, Chitkara University, Himachal Pradesh, 174103, India
  • 20 University Center for Research and Development, Chandigarh University, Mohali, Punjab, India
BMC Public Health, 2024 Nov 18;24(1):3200.
PMID: 39558300 DOI: 10.1186/s12889-024-20746-9

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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