BACKGROUND:
The rate of smoking among pregnant civilian women in Kitsap County, Washington, dropped from 12% in 2013 to 8% in 2014 (p<0.001). For the first time in over 20 years, the county rate was below the state. While seemingly positive, this drop coincided with both a decline in youth cigarette smoking and dramatic rise in youth use of E-cigarettes (climbing from 6% in 2012 to 19% in 2014). The Kitsap Public Health District had also received anecdotal reports of increased E-cigarette and marijuana use by pregnant women.METHODS: In order to understand community trends of E-cigarette and recreational marijuana use during pregnancy in the absence of existing data sources, we surveyed currently pregnant women aged 18 years or older. Surveys were self-administered in waiting rooms of Kitsap County prenatal care providers. The healthcare provider working in these clinics were also surveyed to assess perceptions about the prevalence of smoking, E-cigarette, and recreational marijuana use among their patients, current regional practices for cessation counseling, and availability of educational resources.
RESULTS: A total of 468 surveys were completed by pregnant women during June 2016. The majority (37%) were 24-28 years old and Caucasian (78%); 41% were covered by Medicaid. In the 3 months prior to pregnancy, 20% reported smoking, but this declined to 10% during the last 30 days of their current pregnancy. Younger women (18-23 years) reported smoking more often than older women (32% vs 17%, p=0.002). E-cigarette use rates were slightly lower, at 7% during the 3 months prior to pregnancy and down to 3% during the last 30 days. Recreational marijuana use was 17% prior and 10% during. Eight of fourteen (57%) providers responded to the survey. Most (63%) reported they do not ask nicotine users whether they smoke tobacco cigarettes or use e-cigarettes. Only 36% offer educational materials about tobacco cigarettes to their pregnant patients and none provide materials regarding e-cigarettes. The majority (75%) of providers believe they would benefit from receiving more scientific resources and patient educational materials related to e-cigarette and marijuana use in pregnancy.
CONCLUSIONS: These findings are the first local estimates of e-cigarette and marijuana use during pregnancy. While e-cigarette use appears to be less prevalent than cigarette use, marijuana use is comparable to cigarettes. Our findings document the risk some women are taking and that most local providers don’t have access to educational information for their patients or for themselves.