The use of electronic nicotine delivery systems during pregnancy and the reproductive outcomes: A systematic review of the literature

Abstract

INTRODUCTIONUse of electronic nicotine delivery systems (ENDS) among pregnant women is of great concern. To our knowledge the current literature provides conflicting views regarding the uncertainties of the effects of ENDS use during pregnancy on the health of the fetus.METHODSWe searched PubMed, CINAHL, and EMBASE, for the period 2007 to October 2017 for terms to identify publications on ENDS use during pregnancy and the reproductive outcomes. We updated the search for the period November 2017 to November 2018 using Ovid Medline. We obtained full text of articles and present a summary of the contents.RESULTSWe found no studies of pregnant women exposed to ENDS use and its effect on their fetus or neonates. However, there is a growing body of experimental studies in animals that suggest that nicotine in ENDS alters DNA methylation, induces birth defects, reduces the birth weight, and affects the development of the heart and lungs of their offspring. A large population-based cohort study in the United States estimated that 5% of pregnant women were current ENDS users in 2014; most of them also smoked cigarettes. Surveys conducted among practitioners indicate that there is a need to screen and counsel pregnant women. Systematic reviews and meta-analysis of studies of women who used smokeless tobacco during pregnancy suggest that prenatal nicotine alone is a risk factor for low birth weight, premature delivery, and stillbirth.CONCLUSIONSThere were no previous studies assessing the reproductive effects of ENDS use during pregnancy. However, prenatal exposure to nicotine is known to be harmful to the fetus and the pregnancy.

Exposure to Tobacco, Environmental Tobacco Smoke and Nicotine in Pregnancy: A Pragmatic Overview of Reviews of Maternal and Child Outcomes, Effectiveness of Interventions and Barriers and Facilitators to Quitting

“…Although a controversial topic in tobacco control [96], there was no systematic review evidence on the effect of e-cigarettes in pregnancy, due to a lack of empirical studies. In the US, prevalence of e-cigarette use among pregnant women is 4.9% to 15% [97]. Some evidence suggests that e-cigarettes are a safe alternative to tobacco smoking and can be used a as a smoking cessation aid, however the present research is inconclusive, especially in pregnancy, where there is no research yet to support or condemn their use [98].…”

Electronic cigarettes and obstetric outcomes: a prospective observational study

“…One study found over half of pregnant women entering a smoking cessation trial had previously used EC, with these women reporting a higher cigarette consumption pre‐pregnancy and more failed quit attempts . The effects of electronic cigarette use in pregnancy are unknown and there are no data on obstetric outcomes among pregnant EC users . Our objective was to examine obstetric outcomes related to EC use in pregnancy.…”

“…19 The effects of electronic cigarette use in pregnancy are unknown and there are no data on obstetric outcomes among pregnant EC users. 20 Our objective was to examine obstetric outcomes related to EC use in pregnancy. In addition, we sought to determine whether similar socio-demographic factors would apply in this group of mothers.…”

The impact of tobacco chemicals and nicotine on placental development

“…Currently, studies of e-cigarette perception and use in pregnancy are available, and ENDS use in pregnancy is estimated to be between 1.2% and 5%. 15,99 To-date, there are no published studies as to how ENDS use affects pregnancy outcome or fetal development. Such studies are lacking and yet sorely needed for physicians to understand the unique risks associated with ENDS use in pregnancy.…”

“…Studies specifically focused on maternal and neonatal outcomes with ENDS use are lacking. 15 Much of our understanding of nicotine exposure on fetal development comes from studies using animal models, including mouse, rat, and nonhuman primates. With such models, doses of nicotine are administered through use of implanted osmotic pumps or daily subcutaneous injections.…”