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To estimate the risk attributable to e-cigarettes, the Pregnancy Risk Assessment Monitoring System (PRAMS) cohort followed up with 79176 pregnant women in the US and reported in 2021 that exclusive e-cigarette use during pregnancy was as harmful as exclusive use of combustible cigarettes either product producing about twice the risk (relative to no maternal use of tobacco in any form) of adverse neonatal outcomes such as preterm birth and low birth weight 15