Patterns and Trends in Use of Electronic Nicotine Delivery Systems Before and During Pregnancy: Pregnancy Risk Assessment Monitoring System, United States, 2016-2019

J Community Health. 2022 Apr;47(2):351-360. doi: 10.1007/s10900-021-01055-3. Epub 2022 Jan 13.


Introduction: This study used 2016-2019 Pregnancy Risk Assessment Monitoring System data to estimate prevalence of electronic nicotine delivery system (ENDS) use around pregnancy, changes in ENDS use and cigarette smoking from before to during pregnancy, and trends in these behaviors over time.

Methods: ENDS and cigarette use during the 3 months before and the last three months of pregnancy were measured. Weighted prevalence estimates and 95% confidence intervals were estimated for outcomes overall and ENDS use by maternal characteristic for 2016-2019; logistic regression tested for differences in ENDS use by maternal characteristic and for linear trends in ENDS and cigarette use before and during pregnancy. Analyses were completed in 2021.

Results: In 2019, 4.3% (N = 98,050) of women used ENDS before and 1.3% (N = 28,811) used ENDS during pregnancy. Most exclusive ENDS users (82.2%) and exclusive cigarette smokers (55.0%) stopped use during pregnancy. Among dual users, 46.3% stopped use during pregnancy while 20.2% continued dual use and 24.9% smoked cigarettes exclusively. Few dual users (8.6%) and exclusive cigarette smokers (0.5%) reported using ENDS exclusively during pregnancy. From 2016-2019, exclusive ENDS use increased and exclusive cigarette smoking decreased both before and during pregnancy.

Conclusions: ENDS use during pregnancy is low but increased since 2016. Less than one-half of dual ENDS and cigarettes users quit during pregnancy; few dual users or exclusive cigarette smokers switched to exclusive ENDS use during pregnancy. Continued surveillance of ENDS and other tobacco use during pregnancy is critical to inform public health activities that protect maternal and child health.

Keywords: Cigarette smoking; Electronic nicotine delivery systems; PRAMS; Pregnancy; Tobacco use.

MeSH terms

  • Child
  • Electronic Nicotine Delivery Systems*
  • Female
  • Humans
  • Nicotine
  • Pregnancy
  • Risk Assessment
  • Smokers
  • Tobacco
  • Tobacco Products*
  • United States / epidemiology


  • Nicotine