Vaping nicotine is associated with increased medically-attended COVID-19 in women of reproductive age in an integrated health system.

BACKGROUND

Vaping in adolescents and young adults is increasingly common and has been shown to cause deleterious effects. Little is known about the effects of vaping on risk of coronavirus disease 2019 (COVID-19) among women of reproductive age. This study evaluated whether vaping nicotine and/or cannabis during the year before pregnancy was associated with medically-attended COVID-19 episodes.

METHODS

This large multicenter cross-sectional retrospective study evaluated women universally screened for vaping during the year before pregnancy as part of standard prenatal care from 9/1/2021 to 3/31/2023. Data came from the electronic health record and included nicotine and/or cannabis vaping during the year before pregnancy (exposure), medically-attended COVID-19 episode during the year before pregnancy (outcome), current and 5-year-history of tobacco smoking status, age, race/ethnicity, neighborhood deprivation index, body mass index, parity and Elixhauser Comorbidity Score. Associations between vaping and medically-attended COVID-19 episodes were estimated using Targeted Maximum Likelihood Estimation (TMLE) adjusting for covariates. Sensitivity analyses were performed after excluding women who had a history of current/former tobacco smoking.

RESULTS

The sample of 71,508 reproductive-aged women had a mean (standard deviation) age of 31.7 (5.2) years and 67.6% were non-White. Overall, 2,347 (3.3%) reported vaping nicotine and 3,505 (4.9%) reported vaping cannabis during the year before pregnancy (2.47% vaped nicotine only, 4.10% vaped cannabis only, and 0.81% vaped both). The prevalence of having a medically-attended COVID-19 episode was higher among those who vaped vs. did not vape nicotine (16.9% vs. 14.1%) and among those who vaped nicotine only (17.0%) or nicotine and cannabis (16.8%) vs. neither (14.1%). In the adjusted analyses, the prevalence of a medically-attended COVID-19 episode was greater among those who vaped nicotine (vs. no nicotine vaping) [adjusted prevalence ratio (aPR) =1.33, 95% confidence interval (CI): 1.16-1.53] and among those who vaped nicotine only (aPR =1.32 (05% CI: 1.14-1.52) or both nicotine and cannabis (aPR =1.40, 95% CI: 1.28-1.54) vs. those who did not vape. Vaping cannabis was not associated with medically-attended COVID-19 episode risk.

CONCLUSIONS

Vaping nicotine only or in combination with cannabis was positively associated with medically-attended COVID-19 episodes among women during the year prior to pregnancy. Future research is needed to understand the mechanisms underlying this association.