Use of e-cigarettes in pregnancy: A systematic review of evidence published from 2020-2022

Bell, Lauren; Whelan, Maxine E; Thomas, Lucie; Edwards, E. Stephen; Lycett, Deborah; Hayward, Kelly L.; Wilson, Katie; Harrison, Rachel; Patel, Riya

doi:10.1007/s10389-023-02026-9

Cited by 5 publications

(8 citation statements)

References 78 publications

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“…The results are complex to interpret as the quality of the studies, except the RCT, was rated as poor, the types of groups compared varied greatly, and for most outcomes there is mixed evidence. Therefore, consistent with the most recent previous review on this topic [27], the findings are inconclusive.…”

Section: Discussionsupporting

confidence: 57%

“…For the general adult population, at least in the short-to medium term, biomarker research suggests that vaping poses a small fraction of the risk of smoking [12,25,26]. The most recent systematic review of studies examining evidence for the health impact of vaping in pregnancy, including 13 studies published up to February 2022, reported mixed and inconclusive findings and a call for more high-quality evidence [27]. Over the last few years, there has been a proliferation of human studies on the health consequences of vaping during pregnancy and an updated review is urgently needed.…”

Section: Introductionmentioning

confidence: 99%

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Vaping during pregnancy: a systematic review of health outcomes

Ussher,

Fleming,

Brose

2024

BMC Pregnancy Childbirth

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Introduction Smoking during pregnancy is harmful to maternal and child health. Vaping is used for smoking cessation but evidence on health effects during pregnancy is scarce. We conducted a systematic review of health outcomes of vaping during pregnancy. Methods We searched six databases for maternal/fetal/infant outcomes and vaping, including quantitative, English language, human studies of vaping during pregnancy, to November 10th, 2023. We assessed study quality with the Mixed-Methods Appraisal Tool. We focused on comparisons of exclusive-vaping with non-use of nicotine and tobacco products and with smoking. Presentation is narrative as the studies were of insufficient quality to conduct meta-analysis. Results We included 26 studies, with 765,527 women, with one randomised controlled trial (RCT) comparing vaping and nicotine replacement therapy for smoking cessation, 23 cohort studies and two case–control studies. While the RCT met 4/5 quality criteria, the quality of the cohort studies and case–control studies was poor; none adequately assessed exposure to smoking and vaping. For studies comparing exclusive-vaping with ‘non-use’, more reported no increased risk for vaping (three studies) than reported increased risk for maternal pregnancy/postpartum outcomes (one study) and for fetal and infant outcomes (20 studies no increased risk, four increased risk), except for birth-weight and neurological outcomes where two studies each observed increased and no increased risk. When the RCT compared non-users with those not smoking but vaping or using NRT, irrespective of randomisation, they reported no evidence of risk for vaping/NRT. For studies comparing exclusive-vaping and exclusive-smoking, most studies provided evidence for a comparable risk for different outcomes. One maternal biomarker study revealed a lower risk for vaping. For small-for-gestational-age/mean-birth-centile equal numbers of studies found lower risk for vaping than for smoking as found similar risk for the two groups (two each). Conclusions While more studies found no evidence of increased risk of exclusive-vaping compared with non-use and evidence of comparable risk for exclusive-vaping and exclusive-smoking, the quality of the evidence limits conclusions. Without adequate assessment of exposure to vaping and smoking, findings cannot be attributed to behaviour as many who vape will have smoked and many who vape may do so at low levels. Study registration https://osf.io/rfx4q/.

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Vaping during pregnancy: a systematic review of health outcomes

Ussher,

Fleming,

Brose

2024

BMC Pregnancy Childbirth

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show abstract

“…The results are complex to interpret as the quality of all the studies except the RCT was rated as poor, the types of groups compared varied greatly, and for most outcomes there is mixed evidence. Therefore, consistent with the most recent previous review on this topic, which included 13 studies [27], the ndings are inconclusive.…”

Section: Discussionsupporting

confidence: 56%

“…For the general adult population, at least in the short-to medium term, biomarker research suggests that vaping poses a small fraction of the risk of smoking [25,26]. The most recent systematic review of studies examining evidence for the health impact of vaping in pregnancy, including 13 studies published up to February 2022, reported mixed and inconclusive ndings and a call for more high-quality evidence [27]. Over the last few years, there has been a proliferation of human studies on the health consequences of vaping during pregnancy and an updated review is urgently needed.…”

Section: Introductionmentioning

confidence: 99%

Vaping during pregnancy: A systematic review of health outcomes

Ussher,

Fleming,

Brose

2024

Preprint

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Introduction Smoking during pregnancy is harmful to maternal and child health; vaping is used for smoking cessation but evidence on health effects during pregnancy is scarce. We conducted a systematic review of health outcomes of vaping during pregnancy. Methods We searched six databases for maternal/fetal/infant outcomes and vaping, including quantitative, English language, human studies of health consequences of vaping during pregnancy, to November 10th, 2023. We assessed study quality with the Mixed-Methods Appraisal Tool. We focused on comparisons of exclusive-vaping with non-use of nicotine and tobacco products and with smoking, with narrative presentation. Results We included 26 studies, with 765,527 women, with one randomised controlled trial (RCT) comparing vaping and nicotine replacement therapy for smoking cessation, 23 cohort studies and two case-control studies. While the RCT met 4/5 quality criteria, quality of the cohort studies and case-control studies was poor; none adequately assessed exposure to smoking and vaping. For studies comparing exclusive-vaping with ‘non-use’, more reported no increased risk for vaping (three studies) than reported increased risk for maternal pregnancy/postpartum outcomes (one study) and for fetal and infant outcomes (20 studies no increased risk, four increased risk), except for birth-weight and neurological outcomes where two studies each observed increased and no increased risk. When the RCT compared non-users with those not smoking but vaping or using NRT, irrespective of randomisation, they reported no evidence of risk for vaping/NRT. For studies comparing exclusive-vaping and exclusive-smoking, most studies provided evidence for a comparable risk for different outcomes. One maternal biomarker study revealed a lower risk for vaping. For small-for-gestational-age/mean-birth-centile equal numbers of studies found lower risk for vaping than for smoking as found similar risk for the two groups (two each). Conclusions While more studies found no evidence of increased risk of exclusive-vaping compared with non-use and evidence of comparable risk for exclusive-vaping and exclusive-smoking, the quality of the evidence limits conclusions. Without adequate assessment of exposure to vaping and smoking, findings cannot be attributed to behaviour as many who vape will have smoked and many who vape may do so at low levels. Registration number of protocol for this review https://osf.io/rfx4q/

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“…The safe, remote, provision of NRT, which can help to address nicotine withdrawal and likely increases smoking cessation during pregnancy [ 31 ], could further enhance the effectiveness of digital support. Similarly, while the safety of electronic cigarettes (e-cigarettes) in pregnancy remains unclear [ 32 ], there is a rapid emergence of evidence in this area, including a recent randomised control trial demonstrating their potential efficacy as a smoking cessation tool in pregnancy [ 33 ]. E-cigarette use is supported in the STP [ 13 ] and therefore it is important to improve understanding of how e-cigarettes could potentially be provided remotely to increase cessation should provision become standard care in the future.…”

Section: Introductionmentioning

confidence: 99%

Experts’ views on translating NHS support to stop smoking in pregnancy into a comprehensive digital intervention

McDaid,

Belderson,

Emery

et al. 2024

PLOS Digit Health

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Many pregnant smokers need support to quit successfully. In the United Kingdom, trained smoking cessation advisors deliver structured behavioural counselling alongside access to free nicotine replacement therapy (NRT); known as the ‘Standard Treatment Programme’ (STP). Pregnant smokers who access STP support are more likely to quit, but uptake is low. A digital intervention could be offered as an adjunct or alternative to existing STP support to increase cessation rates. However, there are few pregnancy-specific digital options routinely available and, among those that are, there is limited evidence of their effectiveness. This study investigated experts’ views on the feasibility of translating the STP into a comprehensive digital intervention. Virtual group and individual interviews were undertaken with 37 experts (11 focus groups, 3 interviews) with a real-time voting activity in the focus groups to prompt discussion. Framework Analysis was applied to the data to examine themes and patterns. Experts were supportive of a digital translation of the STP and considered most behavioural counselling content to be transferable. However, replicating human-to-human accountability, empathy and the ability to go ‘off-script’ was thought more challenging. Suggestions for how this might be achieved included tailoring and personalisation, use of artificial intelligence tools, peer support and the option to escalate contact to a human advisor. Experts had mixed views on the role that exhaled breath carbon monoxide monitoring might have in a digital cessation intervention for pregnancy. Electronic provision of free NRT, and potentially e-cigarettes, without interpersonal support was generally well received. However, experts had concerns about it exacerbating low NRT adherence, governance issues (e.g. being accountable for the suitability of recommended products), and people’s ability to misrepresent their eligibility. The STP was considered largely transferable to a digital intervention and potentially helpful for cessation in pregnancy, so merits further development and evaluation.

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Use of e-cigarettes in pregnancy: A systematic review of evidence published from 2020-2022

Cited by 5 publications

References 78 publications

Vaping during pregnancy: a systematic review of health outcomes

Vaping during pregnancy: a systematic review of health outcomes

Vaping during pregnancy: A systematic review of health outcomes

Experts’ views on translating NHS support to stop smoking in pregnancy into a comprehensive digital intervention

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