Use of heated tobacco products may be associated with hypertensive disorders of pregnancy and low birth weight in Japan: An analysis of the JACSIS study
Background: Little is known about heated tobacco product (HTP) use in pregnant women and associated maternal and neonatal risks for hypertensive disorders of pregnancy (HDP) and low birth weight (LBW). Thus, this study aimed to assess the status of HTP use among pregnant women in Japan and explore the risk of HDP and LBW associated with HTP use. Methods: Using data from the Japan "COVID-19 and Society" Internet Survey (JACSIS) study, a web-based nationwide survey, we investigated 558 post-delivery and 365 currently pregnant women in October 2020. We assessed the prevalence of ever HTP smokers (defined as ever experiencing HTP use) in post-delivery and currently pregnant women. Among post-delivery women, we collected the information regarding HDP and LBW based on their Maternal and Child Health Handbooks (maternal and newborn records). In the multivariable regression analysis, we estimated the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of ever HTP smokers for HDP and LBW compared with those of never HTP smokers using logistic regression. A stratified analysis with respect to combustible cigarette smoking (never/ever) was also performed. Results: The prevalence of ever HTP use were 11.7% and 12.6% in post-delivery and currently pregnant women, respectively. Among post-delivery women, ever HTP smokers had higher HDP incidence (13.8% vs. 6.5%, P=0.03), with an OR of 2.78 (95% CI 0.84--9.15) and higher LBW incidence (18.5% versus 8.9%, P=0.02), with an elevated OR of 2.08 (95% CI 0.80--5.39). A similar tendency was observed among never and ever combustible cigarette smokers. Conclusion: In Japan, the incidence of HTP use has exceeded 10% among pregnant women, and HTP smoking may be associated with increased maternal and neonatal risks. School-based tobacco prevention and cessation programs should be conducted regardless of product types to prevent life-threatening perinatal complications and deaths.
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