Electronic Nicotine Delivery Systems (ENDS) Use and Pregnancy II: Perinatal Outcomes Following ENDS Use During Pregnancy

Abstract

Purpose of Review This review examines the risk of adverse perinatal outcomes following electronic nicotine delivery systems (ENDS) use during pregnancy, and considers whether there are sufficient data to support ENDS as a harm reduction approach during pregnancy. Recent Findings Seven papers assessed perinatal outcomes following ENDS use during pregnancy. There was evidence that ENDS use was associated with increased risk for some adverse perinatal outcomes (e.g., small for gestational age). However, the repeated use of data sets, insufficient data (e.g., timing of ENDS use, type of ENDS products used), and limited samples sizes contributed to mixed findings on the degree to which ENDS use (alone or in combination with combustible cigarettes (CC)) impacts the risk of adverse perinatal outcomes relative to CC smoking alone. Summary The current data are still insufficient to support ENDS as a harm reduction approach, though findings do warrant concern and more detailed investigation of ENDS use during pregnancy. Future research directions, as well as implications for clinical recommendations and tobacco regulatory science, are discussed.

E-Cigarettes—a review of the evidence—harm versus harm reduction

“… 38 Due to the lack of reliable evidence, there is broad consensus across public health agencies and professional organizations globally, that use of e-cigarettes should be avoided during pregnancy, regardless of smoking status and not be used as a harm reduction tool at this time. 38 - 40…”

“…DeVito, et al, reviewed 7 studies and found some preliminary data that e-cigarette use may be associated with poor perinatal outcomes, such as small for gestational age; however, there was insufficient data and small sample sizes which limited certainty of findings. 38 Due to the lack of reliable evidence, there is broad consensus across public health agencies and professional organizations globally, that use of e-cigarettes should be avoided during pregnancy, regardless of smoking status and not be used as a harm reduction tool at this time. [38][39][40] The existing evidence suggests exposure to toxicants and carcinogens from e-cigarettes is most likely less harmful than from combustible tobacco products.…”

“…38 Due to the lack of reliable evidence, there is broad consensus across public health agencies and professional organizations globally, that use of e-cigarettes should be avoided during pregnancy, regardless of smoking status and not be used as a harm reduction tool at this time. [38][39][40] The existing evidence suggests exposure to toxicants and carcinogens from e-cigarettes is most likely less harmful than from combustible tobacco products. It is important to note that the evidence does not indicate that e-cigarettes are harmless.…”

Association of maternal snuff use and smoking with Sudden Infant Death Syndrome: a national register study

“…9 Approximately 1.8% of Swedish women used snuff in pregnancy in 2021. 9 Whereas sufficient knowledge about nicotine exposure from electronic cigarettes in pregnancy still are lacking, 10,11 maternal snuff use has been associated with increased risk of stillbirth, preterm birth, neonatal apnea, and disturbed heart rate variability. [12][13][14][15] However, in contrast to smoking, snuff use has not been associated with increased risk of early neonatal mortality.…”