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Vaping During Pregnancy: Lesser of Two Evils or Wolf in Sheep’s Clothing?
Citation:
Rogers, J. Vaping During Pregnancy: Lesser of Two Evils or Wolf in Sheep’s Clothing? IN: Birth Defects Insights, ICP Information Newsletter, Hadley, MA, N/A, (2016).
Impact/Purpose:
This is an invited Blog article for the Teratology Society's Blog "Birth Defect Insights"
Description:
Electronic cigarettes are also called electronic nicotine delivery systems (ENDS), the most descriptive term and the one I will use here. Why do I bring this up? Because, as a biologist and developmental toxicologist by profession, the risks associated with smoking and ENDS use is a professional interest. ENDS are here, they’re trending and they’re not going away anytime soon. So what does this mean for future generations? Particularly the ones growing in the wombs of many women exposed to the vaping culture? I’m calling on all scientists to take a closer look at the topic…first at the trends…Where there’s smoke, there’s vaping.Despite the disturbing headlines, vaping is on the rise. A 2013 study conducted by the Centers for Disease Control and Prevention (CDC) and Georgia State University, found that from 2010 to 2013, awareness of ENDS grew to 80% and use of them more than doubled among U.S. adults. What may be equally, if not more disturbing is the early indication coming out of small studies that many pregnant women may escape to vape because of a presumption that ENDS are safer for the fetus than traditional smoking. Their rising use raises a lot of questions, but with few answers yet. What we do know is that ENDS are unregulated.ENDS are currently unregulated and highly variable in what they deliver in their vapor, including levels of nicotine. Heavy metals such as tin, chromium and nickel have been found in aerosols from some ENDS, along with propylene glycol, glycerol, and flavorings. While e-cigarettes are being marketed as an aid to smoking cessation, none has been approved by the FDA for this use. The U.S. Preventive Services Task Force (USPSTF)3 has concluded that nicotine replacement products (e.g., nicotine patch) and other pharmaceuticals for smoking cessation (varenicline and bupropion) have not been adequately tested for safety and efficacy during pregnancy, and the USPSTF and The American College of Obstetricians and Gynecologists4 recommend that clinicians offer pregnancy-tailored smoking cessation counseling for smokers.Research is lacking on using ENDS during pregnancy, but we know a lot about nicotine. As nicotine delivery devices, ENDS deliver a known human developmental toxicant that targets, at least, the developing brain and lungs. The dose of nicotine delivered during vaping is not well known and likely highly variable. Considering dose and potency, nicotine is probably the most toxic of tobacco smoke constituents for the developing conceptus. Delivered doses of solvents, flavorings and contaminants are poorly understood. While ENDS aerosols contain far fewer chemicals than tobacco smoke, there are no comparative studies showing that they are safer for pregnancy. How does the availability of ENDS affect decisions about smoking during pregnancy? All other things being equal, if a pregnant woman cannot quit smoking during pregnancy, e-cigarettes might be a safer (but not safe) substitute. But all other things are not equal. Does having the ENDS option reduce the rate of smoking cessation, which is the desired outcome, or is it a step in the right direction? Further, most women smokers at least reduce the number of cigarettes per day during pregnancy, which may result in less nicotine exposure than switching to ENDS. But the most insidious effect of ENDS on pregnancy may originate years earlier; the sharp rise in use by previously non-smoking teens will result in increased nicotine addiction inevitably extending into pregnancy for many. So the number of exposed pregnancies may show a sharp rise in the future due to today’s successful marketing of ENDS to adolescents.
