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Am J Perinatol 2023; 40(10): 1033-1039
DOI: 10.1055/a-2024-0987
SMFM Fellowship Series Article

Waterpipe Tobacco (Hookah) Use in Pregnancy: Associations with Nausea and Vomiting of Pregnancy

Anna R. Whelan 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
,
Alexis C. Gimovsky
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
,
Nancy C. Jao 
2   Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
,
Erika F. Werner
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, Massachusetts
,
Chrystal Vergara-Lopez
4   Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
5   Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
,
Laura R. Stroud
4   Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
5   Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
› Author Affiliations
Funding Funding for this study and manuscript preparation was supported by the National Institute on Drug Abuse (NIDA) of the National Institutes of Health and the Center for Tobacco Products of the U.S. Food and Drug Administration (FDA) under grant 5R01 DA042484 to Laura R. Stroud, PhD, and Lori A. J. Scott-Sheldon, PhD. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration. NIDA, CTP, and FDA had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the manuscript for publication.
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Abstract

Objective Waterpipe tobacco (WPT) use is common among reproductive age patients and is often perceived as safer than cigarette use. Prior studies have shown a decrease in nausea and vomiting symptoms among pregnant women who use cigarettes, but no studies to date have examined these symptoms in pregnant women who use WPT. This study was aimed to investigate the extent of symptoms of nausea/vomiting of pregnancy among participants who self-reported WPT use during pregnancy.

Study Design Secondary analysis of a prospective cohort study examining WPT use during pregnancy. Participants completed the Pregnancy-Unique Quantification of Emesis (PUQE) during first and third trimesters. Medical conditions were determined by medical record review. Participants were evaluated by sole WPT use versus dual/polysubstance WPT use and frequency of WPT use.

Results Ninety-nine (100%) participants completed the PUQE questionnaire during first trimester and 82 (82.8%) completed the PUQE during third trimester. Almost all (91.9%) participants reported moderate nausea/vomiting symptoms at both assessments. There was no difference in frequency of WPT use in pregnancy or rates of dual/polysubstance WPT use in participants with all levels of the PUQE questionnaire. There was also no difference in rates of WPT use or PUQE scores between sole WPT users and dual/polysubstance users. When comparing low and high WPT use, those who were in the higher frequency use group had higher waterpipe dependence scale scores (7.2 vs. 5.3, p < 0.02). With regard to maternal medical comorbidities, the only difference between groups was that sole WPT users were more likely to have a diagnosis of asthma than dual/polysubstance users (36.8 vs. 14.9%, p < 0.02).

Conclusion There were no differences in symptoms of nausea and vomiting of pregnancy or medical conditions in pregnant women who use WPT with any frequency during pregnancy. However, sole WPT users had higher rates of asthma than dual/polysubstance WPT users.

Key Points

  • Waterpipe tobacco use is one of the most common forms of tobacco use among reproductive age patients.

  • Waterpipe tobacco use was not associated with any changes in nausea/vomiting of pregnancy symptoms.

  • Future research on the use of waterpipe tobacco in pregnancy can aid in public health responses.

Keywords

waterpipe tobacco - hookah - pregnancy - nausea and vomiting of pregnancy - tobacco

Note

The study was approved by the Institutional Review Board at Brown University. All participants provided informed, written consent.


Authors' Contributions

L.R.S., N.C.J., C.V.-L., and E.F.W. designed and performed the parent survey study. A.R.W. and A.C.G. performed secondary analysis and wrote this manuscript. The manuscript was edited by L.R.S., E.F.W., N.C.J., and C.V.-L.




Publication History

Received: 11 July 2022

Accepted: 26 January 2023

Accepted Manuscript online:
01 February 2023

Article published online:
07 March 2023

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