Between Concern and Uncertainty: How Health-Care Professionals Approach Smoking and Vaping in Pregnancy

INTRODUCTION: Tobacco and nicotine use in pregnancy poses risks to maternal and fetal health, from both traditional cigarettes (TCs) and e-cigarettes (ECs). This study examines the extent to which health-care professionals in pregnancy care address TC and EC use, provide counseling, and how factors such as risk perception and professional training influence these practices. METHODS: This exploratory cross-sectional online survey among gynecologists, midwives, and social workers (N = 347) evaluated differences in risk perception, assessment, and counseling on TC smoking and EC use in pregnancy. Analyses included Pearson correlations, and Wilcoxon tests corrected for multiple testing, as well as a Multivariate Analysis of Variance (MANOVA) with pairwise comparisons. RESULTS: TC use was considered significantly more risky compared to EC, with larger differences regarding maternal health (η2 = 0.196) compared to fetal health (η2 = 0.137). Nevertheless, EC use was significantly less frequently assessed (η2 = 0.368) and counseled for (η2 = 0.386) compared to TC smoking. More extensive knowledge on TC and EC was associated with higher risk perceptions, more frequent assessment, and more frequent counseling (ρ = 0.19-0.40). Assessment and counseling for TC were less frequent with higher self-rated training need on TC (ρ = -0.25 to -0.30). Social workers reported less assessment and counseling, respectively, as well as less knowledge both for TC and EC (p < .00001) compared to other professions. CONCLUSIONS: Findings reveal TC is perceived as slightly more harmful than EC but addressed notably less often. Greater knowledge was linked to higher risk perception and more frequent assessment and counseling. IMPLICATIONS: Given the central role of knowledge and training for clinically relevant outcomes, targeted training programs seem appropriate to increase assessment and counseling frequency. They may need to be tailored to specific professional groups and should enhance health-care professionals' confidence in addressing both TC and EC equally. Improved translation of clinical guidelines into practice, combined with evidence-based education can support consistent risk communication and cessation counseling, ensuring equitable care during pregnancy.