New research has confirmed that pregnant women who smoke should consider switching to electronic cigarettes and is very important as it comes from the United States. While there has been a growing number of quality studies in the United Kingdom, similar findings coming from the USA carries a lot of weight due to the anti-vaping atmosphere in political and research circles there.
The paper, “Cigarette Smoking Abstinence Among Pregnant Individuals Using E-Cigarettes or Nicotine Replacement Therapy”, has been published in JAMA Network Public Health. The research work was conducted by a cross-centre team from the Department of Pediatrics at the State University of New York at Buffalo, the Department of Pediatrics at the University of Washington, and the Department of Health Behaviour at the Roswell Park Comprehensive Cancer Centre.
Why is research looking at pregnant women and vapes important?
It is universally recognised that smoking during pregnancy presents severe health implications to both the mother and the developing child. All obstetricians and gynaecologists strongly recommend that women give up smoking during pregnancy for their health and that of the foetus.
What impact can smoking have on baby’s development in the womb?
Smoking can:
·Stunt foetal growth
·Decrease birth weight
·Lead to the baby being shorter in height
·Reduce head circumference
·Result in a small-for-gestational-age birth
·Lead to premature delivery
·Increase the chance that the baby will need admitting to neonatal intensive care
Experts say that quitting smoking addresses all these points.
How easy do pregnant women find quitting smoking?
While most pregnant women express a desire to stop using tobacco the National Institutes of Health (NIH) reports that only 40% manage to stop smoking.
Of those who successfully quit, the NIH says that half of them are back to their old smoking habit within 6 months – and almost all are smoking again before the baby’s first birthday, presenting renewed challenges to mother and baby.
How do cigarettes lead to poor foetal development?
As well as the presence of huge volumes of toxins in cigarette smoke, carbon monoxide is produced by burning tobacco and binds to haemoglobin in the blood. This prevents the haemoglobin from doing its job to carry oxygen around the mother’s body and across the placenta to the baby. Doctors say that this can lead to obesity, insulin resistance, and hypertension in the children as they grow up.
Vapes do not contain tobacco or burn anything and so they do not produce any carbon monoxide. Also, from analyses that have been carried out, fewer toxins are produced and what toxins are contained in vapour are at significantly reduced volumes to that found in cigarette smoke. This led experts to hypothesise that vaping is considerably safer than smoking – something that has been confirmed in successive UK Government reports.
What did the American research team do?
The team collected data from data 1,329 pregnant women, “to learn more about how e-cigarette or nicotine replacement therapy (NRT) influences smoking cessation later in pregnancy.”
Then they looked to see whether the group who vaped were more or less successful at quitting than the group using NRT products.
Dr Xiaozhong Wen, the corresponding author of the study, said: “Our pregnant patients want to know more about the pros and cons of using e-cigarettes compared to cigarettes. However, we don’t know that much about e-cigarette use during pregnancy, a substantial research gap.”
What did the study find?
As pregnancies approach full term, the research team found that over half of the women using vapes had successfully quit smoking. The group attempting to quit by using NRT were far less successful with only 1 in 5 managing to stop.
Dr Wen said: “In our analysis of subpopulations in the study, we found that people who started using e-cigarettes before pregnancy had an even higher smoking abstinence rate.”
“It’s possible that existing e-cigarette users, meaning those who had started using prior to becoming pregnant, had had positive experiences with these products after an initial adjustment period. It’s possible that using e-cigarettes allows patients to maintain smoking-related physical motions, psychological satisfaction, social behaviours, and interactions with other smokers.”
Additional findings:
The research team discovered that trying to quit through vaping was most popular with women aged 20 to 24 years. Those who successfully substituted their cigarettes with vapes tended to be moderate cigarette smokers (6-10 cigarettes per day) whereas NRT was the preferred option of heavy smokers (smoking over 11 cigarettes a day). While they preferred NRT, the failure rate shows this was a poor choice.
The accomplishment of switching to vaping was also emphasised with a lower take up of behavioural support in the ecig group. Success was achieved despite only 12% of the vapers accessing support whereas 34% of the NRT users tried to combine support with replacement products.
Did the women encounter any problems using vapes or NRT?
The group using nicotine gums, sprays and patches reported that they suffered from side effects including nausea, vomiting, sleep problems and headaches.
The group using vapes did not report these problems and led the team to feel that this also played a part in the success.
The report’s conclusions
The team reported that vapes now offer more options for pregnant smokers to achieve smoking abstinence.
They concluded: “If smokers prefer not to pursue NRT or have negative experiences and low adherence to NRT use, e-cigarettes could be offered as an alternative smoking cessation aid.”
Advice for pregnant smokers in the UK
Anti-smoking charity Action on Smoking and Health says: “Based on the latest evidence, e-cigarettes are significantly less harmful than cigarettes and are an effective aid for quitting. However, it is important to use UK e-liquids which have been regulated by the MHRA and never home-made or illicit vaping substances. Many women who smoke during pregnancy are using e-cigarettes as an aid to quit or cut down and members of the midwifery team may be asked for advice.”
The National Institute for Health and Care Research says: “E-cigarettes are as safe as nicotine patches for pregnant women. They may also be more effective at helping women to quit.”
In conclusion
Pregnant women find it very difficult to quit smoking, the evidence appears to show that the best solution is to try to switch to vaping following a discussion with their midwife.