The use of tobacco products including cigarettes, smokeless tobacco and e-cigarettes during pregnancy is the most important modifiable risk factor associated with adverse maternal, fetal and neonatal outcomes. Screening for tobacco and e-cigarette use during pregnancy can be a powerful tool to assist patients with smoking cessation. Smoking during pregnancy, particularly of combustible tobacco products, is well-known to effect fetal development. What is not well-known is that the use of e-cigarettes does not eliminate the risk of harm to the fetus.
All pregnant women should be asked about smoking, including the use of e-cigarettes. The strong social norms against smoking during pregnancy lead many women to fail to disclose their true smoking habits. Tobacco can be used in ways other that smoking cigarettes. Cigars, pipes and water pipes are also commonly used, along with dissolvable tobacco products like chewing tobacco, snuff and snus, which are placed in the mouth where the nicotine and other chemicals can be absorbed.
Recently, the use of e-cigarettes has been added to the list of habits used by pregnant women continuing to satisfy their nicotine cravings. The thought by most of these women is that e-cigarettes offered a safer alternative to combustible tobacco primarily because e-cigarettes contain less of the harmful chemicals found in combustible tobacco smoke. It should be noted that this is a false sense of security for the developing fetus.
The use of e-cigarettes began to increase in 2014 and has spiraled sharply upward since then. Along with the use of e-cigarettes has come disturbing news about serious lung problems and even death associated with these products. Although many of these lung problems and deaths have been associated with unregulated e-liquids containing THC (the active chemical in marijuana) and vitamin E acetate, some have also occurred in those using commercially available liquids as well. Pregnant women need to keep in mind that even e-liquids that are sold commercially are not truly regulated as to nicotine level and the presence of other compounds in the liquid. When using e-cigarettes you are still exposing your developing fetus to nicotine and, as yet, unknown compounds.
Because the use of e-cigarettes is a relatively new habit, no long term information is available on the effects it has on the user, particularly if those users are pregnant women. Data in the last 3 years indicates that the use of e-cigarettes is associated with significant lung issues. It is unreasonable to believe that nothing will be found in legal or illegal e-cigarette devices that is not harmful to a fetus.
Quitting nicotine use, regardless of how it is obtained, is a very difficult habit to break. Pregnancy is often a time when a woman will make the maximum effort to quit smoking to help protect her developing baby. The use of e-cigarettes is not the answer to smoking cessation. Most studies have shown that e-cigarette users actually use tobacco when the circumstances allow and e-cigarettes when they will not. Pregnant women need to be honest with their doctor about their smoking habits and consider enrolling in a smoking cessation program. The incentive that the pregnancy gives will increase the success of an attempt at smoking cessation.