Is There Evidence for Potential Harm of Electronic Cigarette Use in Pregnancy?

Abstract

Background Use of electronic cigarettes (e-cigarettes) and other nicotine containing products is increasing among women of reproductive age. The short- and long-term effects of these products on both mother and fetus are unknown. Methods Because e-cigarettes are nicotine delivery systems, we sought to conduct a comprehensive review of the effects of nicotine on the fetus. Results In utero nicotine exposure in animal models is associated with adverse effects for the offspring lung, cardiovascular system and brain. In the lung, this included reduced surface area, weight, and volume, as well as emphysema-like lesions. In adulthood, exposed offspring demonstrate elevated blood pressure and increased perivascular adipose tissue. In the brain, exposure alters offspring serotonergic, dopaminergic, and norepinephrine networks, which in turn are associated with behavioral and cognitive impairments. We also review current data on the lack of efficacy of nicotine replacement therapy in pregnant women, and highlight different nicotine containing products such as snuff, snus, and hookah. Conclusion We conclude that no amount of nicotine is known to be safe during pregnancy, and studies specifically addressing this risk are crucial and an imminent public health issue.

The Modified Reasons for Smoking Scale: factorial structure, validity and reliability in pregnant smokers

“…Until now, there is lack of evidence whether NRT – regardless of the method of administration – is effective or safe when used to promote smoking cessation in pregnancy or whether it has positive or negative impacts on pregnancy outcomes. Therefore, further research on the efficacy and safety of NRT during pregnancy is needed, in particular evidence from placebo‐controlled RCTs investigating higher doses of NRT than those already tested in previous studies [31,32]. The use of bupropion and varenicline is contraindicated during pregnancy [33].…”

Substance Use in the Perinatal Period

“…Tobacco use behavior among pregnant women includes cigarette and electronic cigarette smoking [19-21] and smokeless tobacco use [22,23]. These tobacco-related behaviors, as well as second hand smoke exposure [24] remain prevalent in the perinatal population, with 16% of pregnant women reporting smoking [1].…”

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

“…Nicotine, the dependence‐producing drug in ECIGs, is a toxicant of particular concern for pregnant women, as nicotine is known to harm a fetus (e.g., Bruin, Gerstein, & Holloway, ; England et al, ) some have suggested that no amount of nicotine in pregnancy is safe (CDC, ; Suter, Mastrobattista, Sachs, & Aagaard, ). ECIGs differ dramatically in terms of their nicotine delivery, with some products delivering little to no nicotine (e.g., Farsalinos et al, 2014; Vansickel et al, 2010; Yan & D'Ruiz, 2015), and others delivering as much, or more, than a combustible cigarette (e.g., Ramoa et al, 2016; St. Helen, Havel, Dempsey, Jacob III, & Benowitz, ; Wagner et al, ).…”