Electronic nicotine delivery systems and pregnancy: Recent research on perceptions, cessation, and toxicant delivery

Abstract

Electronic nicotine delivery systems (ENDS), which includes e‐cigarettes (ECIGs), are a rapidly‐expanding class of products that heat a liquid (which may or may not contain nicotine) to produce an aerosol. The variation of ECIG components is extensive as are their effects on users. Epidemiological data show that while both adults and youth use ECIGs, use among youth has increased dramatically in recent years. Other epidemiological data show that women of reproductive age and some pregnant women are also using ECIGs. The goal of this article is to provide readers with background information about ECIGs, with a focus on recent findings about ECIG use in pregnancy and potential implications. Among pregnant women, correlates of ECIG use include current cigarette smoking, among other factors. Regarding pregnant women's perceptions of ECIG use in pregnancy, two themes emerge from the literature: many pregnant women perceive ECIGs to be safer than conventional cigarettes, and that ECIGs can aid with smoking cessation. In contrast to these perceptions, there is little concrete evidence that ECIGs help smokers quit. In addition, there are concerns about ECIG nicotine and other toxicant delivery. Nicotine is a toxicant of particular concern for pregnant women, as nicotine is known to harm a developing fetus. There are many limitations to existing research, and the literature is scant in this area. Further, new “pod mod”‐style ECIGs such as JUUL present new challenges. Overall, with limited evidence of their effectiveness, and concerns about developmental toxicology, the authors do not recommend that pregnant women use ECIGs.

The Evolving Landscape of e-Cigarettes

“…Many women perceive e-cigarettes to be safer than tobacco smoking during pregnancy 151 . However, there are currently no human experimental or epidemiological studies which assess the potential for maternal e-cigarette use to impact the health of the developing human fetus.…”

Extracorporeal support to treat E-cigarette or vaping product use-associated lung injury (EVALI) during the coronavirus disease 2019 (COVID-19) pandemic

“…First, there is growing evidence that vaping impairs lung and host immunity. 4 As such, healthy young adults who may not otherwise experience severe respiratory symptoms to seasonal flu or novel viral outbreaks are now likely to become a new "at-risk" group. Vaping status should consequently be routinely entered into the medical record and an effort to should be taken to distinguish EVALI from other respiratory illness in the history by eliciting signs of fever, sore throat, and/or exposure.…”

“…Second, current opinion regarding safety of vaping during pregnancy remains mixed. 4 Emerging evidence suggests that, like smoking, it poses significant risk to the developing fetus. [4][5][6] This is due, in part, to the well-known adverse effects of maternal nicotine exposure on fetal outcomes and postnatal development.…”

“…4 Emerging evidence suggests that, like smoking, it poses significant risk to the developing fetus. [4][5][6] This is due, in part, to the well-known adverse effects of maternal nicotine exposure on fetal outcomes and postnatal development. 6 A single e-cigarette pod (for a JUUL, Sorin, or similar rechargeable device), or disposable e-cigarette stick, can deliver the nicotine equivalent of 4 packs of cigarettes (ie, 20-90 mg nicotine); the ill effects of nicotine exposure to the unborn child are thus cause for great concern.…”

Special issue on “Developmental effects of smoking, vaping, and cannabis use”

“…The JUUL brand ENDS has among the highest concentrations of nicotine, with one JUUL pod estimated to contain as much nicotine as a pack of tobacco cigarettes. Breland, McCubbin, and Ashford (in this issue) discuss the current products available and patterns of usage, especially among adolescents and perceptions about safety for use in pregnancy. Then, what is currently known about the developmental toxicity of ENDS is reviewed by Greene and Pisano (in this issue).…”