A new study published in Nature Medicine found that pregnant smokers were more likely to quit when using e-cigarettes than nicotine patches. The finding is great news, because patches have “limited efficacy in this population,” as the researchers noted—and quitting smoking during pregnancy decreases the risk of a host of adverse health complications to both parent and baby.
The randomized controlled trial began in 2019, enrolling 1,140 pregnant women at 24 hospitals in the United Kingdom. Participants had a median age of 27 years, smoked an average of 10 cigarettes per day, and were on average 15.7 weeks pregnant. The study compared vaping a refillable vaping device to wearing nicotine replacement therapy (NRT) patches.
The 344 participants in the e-cigarette arm and chose e-liquids with a higher nicotine content (11–20 mg ml) with tobacco and fruit flavors. Nicotine is metabolized faster during pregnacy, so it’s critical that people get the right amount of nicotine if they’re not to return to smoking. But interestingly, the study found that 244 participants decreased the nicotine concentration in their e-cigarette liquids significantly over time.
At the end of their pregnancy, 10.7 percent of the women who vaped were abstinent from cigarettes, compared to 5.6 percent of those who used nicotine patches.
“Using an e-cigarette poses no greater risk than nicotine patches, which are both better options than continuing to smoke throughout pregnancy.”
Safety outcomes were similar in the vape and patch groups, except that the mothers who vaped had significantly fewer infants with low birth-weight than those using patches. “This could be a chance finding,” wrote the researchers, “but in a previous large study that compared nicotine and placebo patches, the nicotine arm had better birth and infant outcomes than the placebo arm throughout 2 years after delivery.”
“Both findings could be due to a larger reduction in smoking in the study arms with the more favorable safety outcomes,” they added.
“Many pregnant smokers find it difficult to quit with current stop smoking medications including nicotine patches and continue to smoke throughout pregnancy,” Dr. Francesca Pesola, an author of the new study, told the Guardian. “Using an e-cigarette poses no greater risk to the mother or baby than nicotine patches, which are both better options than continuing to smoke throughout pregnancy.”
The study had some limitations, including not being able to validate abstinence of smoking via saliva samples in all participants—this could be done in only about half of cases.
“The need is made even more urgent by the fact that the link between smoking and socioeconomic disadvantage is particularly strong in women who are pregnant.”
The researchers also reported that the study might have been affected by the outbreak of a lung disease in vapers in the United States that killed about 60 people in 2019. The Centers for Disease Control (CDC) misnamed it “e-cigarette or vaping product use-associated lung injury” (EVALI). It was widely reported in the UK as being related to nicotine vaping, and anecdotal evidence from follow-up calls suggested that the media panic over e-cigarettes use led some participants to stop vaping and return to smoking. This is tragic because nicotine vapes were not the culprit; it was illicitly manufactured THC cartridges tainted with vitamin E acetate that caused the injuries and deaths.
The researchers noted another reason the study was important: “The need to identify stop-smoking interventions that help pregnant women who smoke is made even more urgent by the fact that the link between smoking and socioeconomic disadvantage is particularly strong in women who are pregnant.”
For cigarette smokers who can’t or don’t want to quit during pregnancy, vaping is harm reduction. In the UK, where policies have long been far more pro-vaping than in the US, the National Health Service gives the following advice: “If using an e-cigarette helps you to stop smoking, it is much safer for you and your baby than continuing to smoke.”
Photograph by Amr Tahr via Unsplash