Are e-cigs better for pregnant people trying to quit? New research is at odds with expert advice

By now, most people know that smoking tobacco isn’t great for your health. It can cause cancer, and chronic obstructive pulmonary disease, heart disease, stroke, diabetes and it can even increase a person’s risk for tuberculosis. Commercial tobacco use is the leading cause of preventable disease, according to the Centers for Disease Control and Prevention (CDC). While the U.S. adult cigarette smoking rate reached an all-time low in 2022, e-cigarette use rose. 

For pregnant women, smoking cigarettes is not advised by medical professionals, as fetuses are at risk for birth defects, premature birth and sudden infant death syndrome (SIDS). One study published in the journal Pediatrics reported that sudden infant death rates would be improved “substantially” in the U.S. if expectant moms quit smoking. Yet nicotine has been proven to be as addictive as heroin and cocaine, making it especially difficult to quit.

While the CDC considers e-cigarettes and other nicotine products to be unsafe during pregnancy, new research published in NIHR Journals Library suggests that pregnant women should consider e-cigarettes over nicotine patches when quitting smoking cigarettes entirely is difficult, perhaps signaling a shift in guidance in a potential harm reduction approach.

“Nicotine in nicotine patches or e-cigarettes can in fact reduce this harm if it leads to stopping or reducing smoking.””

In the study, 1,140 pregnant women who were daily smokers trying to quit were split into two groups. In the first group, the women received e-cigarettes. In the second group, they received nicotine patches. Both groups received support calls prior to their target quit date. Researchers said in the study that both options were equally safe. After giving birth, researchers found that the e-cigarette group had fewer children with low birthweight, which has been linked to poor health later in life.

“E-cigarettes seem more effective than nicotine patches in helping pregnant women to quit smoking and because of this, they seem to also lead to better pregnancy outcomes,” Peter Hajek, Director of Health and Lifestyle Research Unit at the Wolfson Institute of Population Health at Queen Mary University of London said in a media statement. “The evidence-based advice to smokers already includes, among other options, a recommendation to switch from smoking to e-cigarettes. Such a recommendation can now be extended to smokers who are pregnant as well.”

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In the study, the researchers state that they found twice as many women quit with e-cigarettes than with nicotine patches after pregnancy. Initially, the researchers did not find that the e-cigarettes group had a significantly better quit rate due to limitations in the saliva return samples: only 55 percent of the study’s participants returned usable samples to determine that they quit smoking. When taking this limitation into account, the researchers state that they found e-cigarettes were twice as effective.

Nicotine patches haven’t been found to be successful in pregnant smokers. In 2012, a study published in the New England Journal of Medicine looked at 1,000 pregnant smokers in the United Kingdom. Half all of them were asked to wear a nicotine patch, and the other half received a placebo. All women received counseling. Researchers found there was no difference in the quit rate between those who wore the patch and those who received the placebo.

Twice as many women quit with e-cigarettes than with nicotine patches after pregnancy.

“[E-cigs] seem better at allowing smokers trying to quit to adjust the nicotine intake to their needs, select flavors they like and retain a degree of enjoyment that they previously obtained from smoking,” Hajek told Salon via email. “The risks of smoking to pregnant women and their babies are primarily from combustion and other tobacco chemicals rather than from nicotine. Nicotine in nicotine patches or e-cigarettes can in fact reduce this harm if it leads to stopping or reducing smoking.”

But what about the chemicals in e-cigs? As Salon has previously reported, concerns have been raised surrounding the safety of the flavoring chemicals inside e-cigarette liquids — many of which are billed by manufacturers as safe because the FDA has approved them for ingestion, but not necessarily inhalation. For example, propylene glycol (PG) is a common ingredient in vaping products.

“It is not considered dangerous and it is approved for use in pregnancy, e.g. in asthma inhalers,” Hajek told Salon. “In this trial, women given e-cigarettes had fewer babies with low birthweight (under 2500 g) than those given the patches, most likely because they smoked less.”

While it might seem counterintuitive, Hajek said e-cigarettes can help pregnant smokers quit. Nonetheless, the study’s results are at odds with current guidance in the U.S. The National Cancer Institute’s informational website SmokeFreeGov advises against e-cigarettes.

“There is little evidence that e-cigarettes help people quit,” SmokeFreeGov states on its website. “Quitting all forms of tobacco products, including e-cigarettes, is best for you and your baby.”

Dr. Melissa Simon, an obstetrician gynecologist at Northwestern University, told Salon via email that the data of this study is “not convincing.”

“I would not endorse these conclusions,” she said. “I think they overstated the conclusions [and] this is not a practice changing study.”

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