Summary
Introduction:
This article reviews the current literature on the relationship between electronic nicotine delivery systems (ENDS) use during pregnancy and adverse perinatal outcomes. The authors synthesize findings from population-based and cohort studies that assessed rates of perinatal outcomes following ENDS use during pregnancy, compared to other tobacco product use categories and no tobacco product use. The review includes details on the characteristics of the product(s) used in each study.
Key Points:
* Seven papers were identified that addressed adverse pregnancy outcomes within individuals who used ENDS during pregnancy.
* The studies primarily categorized tobacco product use based on the last 3 months of pregnancy and differed in the tobacco product use groups assessed, confounds accounted for in analyses, and whether the full or partial dataset was included.
* Cohort studies considered perinatal outcomes and tobacco product use assessed as self-reported past month use (nicotine biomarkers collected) and not restricted to a specific time period within pregnancy, or as 'current' use between 10--14 weeks of gestation.
* The studies found that ENDS use (alone or dual use) during pregnancy may increase the risk of adverse perinatal outcomes relative to no tobacco product use. however, there is limited data directly addressing the question of whether dual use or ENDS only use reduces risk relative to CC smoking during pregnancy, and the available data is equivocal.
* Important gaps in the literature remain, including the relationship of ENDS use on pregnancy outcomes in relation to the timing of use during pregnancy, frequency/heaviness of use, and nicotine level, flavor, and device type used during pregnancy.
* Most analyses did not formally compare ENDS only or dual use with CC only groups; within two that do make this direct comparison, findings are inconsistent.
* The one clinical message that can be clearly discerned from the existing data is that fully quitting ENDS use, CC smoking, and other tobacco product use during pregnancy is optimal.
Main Message:
The current body of evidence does not provide clear support for ENDS as an effective harm reduction strategy for pregnant persons who smoke CCs. The risks and/or harm reduction potential of ENDS during pregnancy is still emerging, and continued research in this area is of high priority. Prompt and thorough assessment of risks of newer tobacco products, such as ENDS, may have significant public health impacts by increasing pregnant persons’ and clinicians’ knowledge as well as informing tobacco regulatory actions, all of which may influence behavior, ultimately sparing adverse health effects for parents and infants.
Citation
DeVito EE, Fagle T, allen aM, et al. Electronic Nicotine Delivery Systems (ENDS) Use and Pregnancy II: Perinatal Outcomes Following ENDS Use During Pregnancy. Current addiction reports. 2021;8(3):366-379. doi:10.1007/s40429-021-00381-9
