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The Use of Electronic Cigarettes in Pregnancy: A Review of the Literature

Whittington, Julie R., MD*; Simmons, Pamela M., DO; Phillips, Amy M., MD; Gammill, Sarah K., BS§; Cen, Ruiqi, MPH; Magann, Everett F., MD; Cardenas, Victor M., MD, PhD**

Obstetrical & Gynecological Survey: September 2018 - Volume 73 - Issue 9 - p 544–549
doi: 10.1097/OGX.0000000000000595
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Importance Electronic cigarette (e-cigarette) use in pregnancy has been steadily increasing and has been hyped as being a safe alternative to cigarette smoking during pregnancy. This review discloses what is currently known about e-cigarette use in pregnancy and the effects of its use on pregnancy outcomes.

Objective To determine what is currently known about the prevalence of e-cigarette use in pregnancy and the effects of e-cigarette use on pregnancy and perinatal/neonatal outcomes.

Evidence Acquisition A PubMed, CINAHL, and EMBASE search was undertaken using the search terms “pregnancy” OR “pregnancy complications” OR “pregnancy outcome” OR “newborn” OR “neonate” OR “birth” AND “electronic cigarettes” OR “e-cigarettes” OR “ecigarettes” OR “vaping” OR “vape.” The search was limited to the English language and between 2007 and October 12, 2017.

Results The search identified 91 articles, 40 of which are the basis for this review. The prevalence of e-cigarette use is 0.6% to 15%. The amount of nicotine consumed by e-cigarette users is comparable to that consumed by cigarette smokers. Most of the animal model studies suggest a potential danger to the developing fetus primarily because of the nicotine consumed and that consumption has multiple effects on the immune system, neural development, lung function, and cardiac function. There is a widespread flawed perception that e-cigarettes are safe to use during pregnancy.

Conclusions The marketing of e-cigarette use as a safer alternative to cigarette smoking has led to an increasing use even in pregnancy. The nicotine consumed by e-cigarettes is similar to that consumed by cigarette smoking. Animal studies confirm the dangers of nicotine to the developing fetus. More research needs to be done specifically assessing e-cigarette use, pregnancy, and pregnancy outcomes.

Relevance The amount of nicotine consumed in cigarette smoking is similar to the amount of nicotine consumed with e-cigarettes. The effects of nicotine exposure during fetal development are well known and include effects on multiple organ systems.

Target Audience Obstetricians and gynecologists, family physicians.

Learning Objectives After completing this activity, the learner should be better able to determine the prevalence of e-cigarette use in pregnancy, analyze and compare the nicotine consumed with cigarette smoking versus the nicotine consumed with e-cigarette smoking, and evaluate the risk in animal studies of the consumption of nicotine on the developing fetus.

*1st Year Maternal Fetal Medicine Fellow,

2nd Year Maternal Fetal Medicine Fellow, and

Associate Professor, Department of Obstetrics and Gynecology, and

§Student, College of Medicine,

Graduate Assistant, Department of Epidemiology, Fay W. Boozman College of Public Health,

Professor, Department of Obstetrics and Gynecology, College of Medicine, and

**Associate Professor, Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR

All authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Everett F. Magann, MD, Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham St, Slot # 518, Little Rock, AR 72205. E-mail: efmagann@uams.edu.

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