Vaping During Pregnancy

Cigarette smoking continues to be the most commonly used method of consuming nicotine.

And while nicotine is not the cause of smoking-related harm, the action of smoking exposes smokers to thousands of other chemicals, many of which are known to be harmful.

Smoking in pregnancy is the leading preventable cause of miscarriage, stillbirth and neonatal deaths.

Quitting smoking is one of the best things you can do for yourself and you baby.

Quitting smoking will reduce the risk of:

• Complications during pregnancy and birth
• Premature birth
• Still birth
• Low birthweight and
• Sudden Infant Death Syndrome (SIDS)

Research has shown that e-cigarettes and other nicotine containing products also help pregnant smokers and that regular use of e-cigarettes or nicotine patches is not associated with adverse outcomes^1,2,3.

According to the NHS, quitting smoking is the best option for pregnant women. However, if stopping nicotine use entirely is not possible, vaping may be a less harmful alternative to smoking. The NHS states that “if e-cigarettes help you stop smoking, it is much safer for you and your baby than continuing to smoke.”

The decision to switch to smoke-free alternatives depends on individual circumstances. Many pregnant smokers find that nicotine replacement therapies (NRT), such as patches and gums, are effective options for reducing or quitting nicotine use.

Pregnancy is often a strong motivator to quit smoking.

But, quitting is not easy and many pregnant women continue to smoke during their pregnancies.

Some people use counselling and support groups to help them quit, but success rates are low. 

Nicotine Replacement Therapies (NRTs), like patches and gums, have been used safely in the general population since the 1970s.

Analysis based on available studies showed that using NRT also helps with quitting both during pregnancy and at the end of pregnancy^1,2,3,4.

NRTs and other products like e-cigarettes are therefore increasingly being used in stop-smoking clinics and are being recommended for use by pregnant women.

The UK National Health Service advises, that both NRTs and e-cigarettes are safer than continued smoking and can be recommended for use by pregnant women:

          “You can use NRT during pregnancy if it will help you stop smoking…” 

          “...if e-cigarettes help you stop smoking, it is much safer for you and your baby than continuing to smoke”

          “...e-cigarettes allow you to inhale nicotine through a vapour rather than smoke. By itself nicotine is relatively harmless”

British health authorities have trained healthcare professionals to support pregnant women struggling to quit smoking - they recommend both nicotine replacement therapies and e-cigarettes to help them stay smoke-free.

The Ministry of Health in New Zealand advises that:

          “...it can be difficult to quit smoking, but there are different tools and services that can help you”

          “For pregnant people who are struggling to be tobacco-free, NRT should be considered.

          “Vaping is less harmful than smoking but its not harmless. Seek advice through your local stop smoking service, doctor, midwife or Quitline.

Below is an overview of some recently published studies on e-cigarettes and other smoke-free nicotine alternatives during pregnancy.

A study² conducted in a large urban hospital in Ireland found that babies born to mothers who abstained from smoking during pregnancy and used e-cigarettes instead had babies with the same birth weight as babies of non-smokers.

Women who smoked or who smoked and vaped gave birth to significantly lower-weight babies.

E-cigarettes have proven to be a more effective than nicotine patches for pregnant women. This has real consequence for health outcomes.

A 2023 study³ involving of 1,140 pregnant women who were interested in quitting assigned these women into two groups: one received e-cigarettes, while the other was given nicotine patches. At the end of the study, significantly fewer women in the e-cigarette group gave birth to low-birth-weight babies compared to those using nicotine patches.

The researchers believe this is likely due to e-cigarettes being more effective at completely replacing traditional cigarettes.

Professor Peter Hajek, head of the Health and Lifestyle Research Unit at Queen Mary University of London, commented:

"E-cigarettes were more effective than nicotine patches in helping pregnant women quit smoking, which in turn positively influenced pregnancy outcomes."

A 2024 study¹ involving 1,100 pregnant smokers in hospitals across 23 cities in England and Scotland assigned participants to use either e-cigarettes or nicotine patches. There were three groups: one using only e-cigarettes, one using nicotine patches, and one continuing to smoke to some extent.

"It turned out that 47 percent of the women chose e-cigarettes, while 21 percent opted for nicotine patches. Some combined the products, while others continued smoking while using one of the nicotine products," the researchers reported.

The study began around the 12th week of pregnancy. Cotinine levels—a biomarker for nicotine in the blood – were measured. Samples were taken at the beginning and end of the study, as well as at a follow-up three months after birth.

The results showed that babies of mothers who used e-cigarettes or nicotine patches had 45 percent lower cotinine levels compared to the start of the study and birth weights comparable to those of non-smokers. In women who continued smoking, cotinine levels remained unchanged or increased, and their babies had significantly lower birth weights (3.1 kg compared to 3.3 kg).

The researchers also examined other complications associated with smoking and newborns. No significant differences were found between the e-cigarette and nicotine replacement therapy groups compared to non-smokers, whereas some negative effects were observed among mothers who continued smoking.

"Using nicotine-containing aids to quit smoking during pregnancy appears to be a safe method. The harm from smoking during pregnancy seems to be primarily due to other chemicals in tobacco smoke rather than nicotine itself," concluded Professor Hajek.

Every individual must make their own decisions about their health during pregnancy. The advice from midwives is important but should be weighed against personal circumstances. Quitting smoking can be challenging, but staying smoke-free during pregnancy means that you and your baby are no longer exposed to the harmful gases in cigarette smoke.