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Hello Colleagues,
Somehow, I came across a flurry of pregnancy and SUD recent publications, including a comparison of methadone and buprenorphine on the 1 and a new report about cannabis and pregnancy outcomes.2 Here we’ll look at vaping (e-cigarettes, or ECs) in pregnancy. Is it safer than smoking combustible cigarettes (CCs)? Is it safe? Should we be recommending it above NRT?
Pharmacotherapies seem to have less effect in pregnancy than in smokers in general. NRT has shown a minimal benefit, and bupropion no effect. Varenicline has not been studied. ECs are known to be more effective and appealing methods of transitioning away from CCs than NRT in the short term; however, most people who quit CCs will continue to use ECs, therefore remaining nicotine dependent.3 It’s not certain what this means for pregnancy or the developing fetal brain. Nicotine is a teratogen in animal studies when administered in chronic high doses, but its safety in human pregnancy, with typical use of nicotine products (other than CCs), is unknown. Previous studies on NRT or vaporized nicotine in human pregnancy show mixed results, ranging from no negative effects to associations with preterm birth and low birth weight.
In RCT, which was a parent trial to this one4, there was no difference in CC quit rate between NRT and EC, but there were a lot of crossovers (i.e., many of those assigned NRT used ECs). When the crossovers were excluded crossovers (which introduces some bias), ECs were more effective than NRT in helping pregnant people quit CCs (6.8% ECs vs 3.3 NRT%, p=0.02, NNT =29).
While the question of efficacy in pregnancy remains a bit uncertain, there is still the question of harm. This study - a secondary analysis of data from the parent study that allows a concentrated look at the people who actually used nicotine products- suggests that vaping nicotine is not worse than using NRT, and it may be safer than CCs. But messaging5 is important. One news outlet summarized this study with the attractive title ‘Using e-cigarettes or nicotine patches while pregnant does not harm the mum or baby, new research shows.’6,7 This study does not give a free pass to ECs in pregnancy. ECs are not medical products, and this data suggests that ECs may help more people transition away from CCs than NRT, but with persistent exposure to nicotine and to vaporized inactive ingredients, both of which may have long-term effects.
Andrea Truncali, MD MPH
Terms: ECs = ecigarettes, electronic cigarettes, ‘vaping’; CCs = combustible cigarettes; nicotine products = ECs or NRT, not CCs
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