Pre-pregnancy depression, prenatal care, and e-cigarette/cigarette use during late pregnancy among adolescents

Xiaozhong Wen; Premini Sabaratnam; Maria V Huber; Najum Z Malik; Andrea L Ruybal; Cassandra A Stanton; Chelsea O McKinney; Comreen Vargees; Erika Westling; Joy L Hart; Shawqi Abu-Taha; Maciej L Goniewicz

doi:10.1093/ntr/ntag104

Pre-pregnancy depression, prenatal care, and e-cigarette/cigarette use during late pregnancy among adolescents

Nicotine Tob Res. 2026 Jun 3:ntag104. doi: 10.1093/ntr/ntag104. Online ahead of print.

Authors

Affiliations

¹ Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 14214, United States.
² Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY 14214, United States.
³ Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, United States.
⁴ Behavioral Health and Health Policy, Westat, Rockville, MD 20850, United States.
⁵ New York Medical College, Valhalla, NY 10595, United States.
⁶ Oregon Research Institute, Eugene, OR 97477, United States.
⁷ Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, KY 40292, United States.
⁸ Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, United States.

PMID: 42231560
DOI: 10.1093/ntr/ntag104

Abstract

Introduction: Although robust evidence shows a link between depression and tobacco use among adolescents, little information exists concerning pregnant adolescents. As such, we examined: 1) the association between pre-pregnancy depression and e-cigarette/cigarette use during late pregnancy, and 2) whether prenatal care visit frequency moderates this association.

Methods: We analyzed data from 10 363 adolescents (ages 19 or younger) in the U.S. Pregnancy Risk Assessment Monitoring System (2016-2021), a national cross-sectional survey supplemented with birth certificates. Participants reported pre-pregnancy depression and e-cigarette and cigarette use in the last 3 months of pregnancy. Multivariable logistic regression models estimated 1) associations of depression with e-cigarette/cigarette use and 2) the interaction between depression and prenatal care visit frequency, adjusting for sociodemographic and pregnancy-related confounders.

Results: Adolescents with pre-pregnancy depression were as likely to use e-cigarettes exclusively during late pregnancy as those without pre-pregnancy depression (3.21% vs. 1.66%; confounder-adjusted odds ratio [aOR], 1.33 [95% CI, 0.78-2.27]). However, those with pre-pregnancy depression were more likely to use cigarettes exclusively (12.72% vs. 4.81%; 1.94 [1.44-2.61]) or use both e-cigarettes and cigarettes (3.50% vs. 0.59%; 4.62 [2.18-9.81]) during late pregnancy. The association between pre-pregnancy depression and exclusive cigarette use was weaker (interaction p < 0.05) among adolescents with 9-11 prenatal care visits (1.38 [0.82-2.32]) and ≥ 12 prenatal care visits (1.77 [1.10-2.84]) compared to those with ≤8 prenatal care visits (3.86 [2.23-6.67]).

Conclusions: Pre-pregnancy depression was associated with cigarette smoking and dual use of e-cigarettes and cigarettes, but not exclusive e-cigarette use, in pregnant adolescents. Frequent prenatal care seemed to partially buffer the elevated risk of cigarette use associated with pre-pregnancy depression in this observational research.

Keywords: Adolescents; Cigarettes; Depression; E-cigarettes/electronic nicotine delivery systems (ENDS)/vaping; Pregnancy; Smoking.