Can e-cigarettes help pregnant people stop smoking?

"It's possible that using e-cigarettes allows patients to maintain smoking-related physical motions, psychological satisfaction, social behaviors, and interactions with other smokers." says Xiaozhong Wen. (Credit: Getty Images)

People who used e-cigarettes before pregnancy were more likely to stop smoking later while pregnant than those using nicotine replacement therapy, according to a new study.

The risks of smoking during pregnancy for both maternal and fetal health are well documented, but only about half of pregnant people quit smoking on their own.

To learn more about how e-cigarette or nicotine replacement therapy (NRT) influences smoking cessation later in pregnancy, researchers compared abstinence rates in the two groups.

The observational study gathered data from 1,329 pregnant people through the US Pregnancy Risk Assessment Monitoring System (PRAMS) between 2016 and 2020. It is one of the first studies in the US to address maternal e-cigarette use.

Pros and cons of e-cigarettes while pregnant

“There is an urgent need for research on maternal e-cigarette use, as e-cigarettes have been increasingly used by young people, including pregnant individuals,” says Xiaozhong Wen, an associate professor of pediatrics in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo and corresponding author of the study published in JAMA Network Open.

As a researcher in the division of behavioral medicine, Wen has conducted multiple studies on smoking cessation during pregnancy and postpartum.

“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,” he says.

The study found that among the 1,329 respondents who had used either e-cigarettes or NRT (a patch, gum, lozenge, etc.) in pregnancy, about half (50.8%) of those who used e-cigarettes reported abstinence later in pregnancy versus 19.4% of those who were using some form of nicotine replacement therapy.

“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 (53.1%) but that those who started using e-cigarettes during their pregnancy had a similar smoking abstinence rate (20.6%) compared to NRT users (19.4%),” Wen says.

Alternative smoking cessation aid

While the reasons for the discrepancy are unknown, Wen hypothesizes that there are a few possibilities that might explain the difference.

“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,” he says. “It’s possible that using e-cigarettes allows patients to maintain smoking-related physical motions, psychological satisfaction, social behaviors, and interactions with other smokers.”

He adds that e-cigarettes don’t typically have the side effects (nausea, vomiting, sleep problems, and headaches) that may affect those using nicotine replacement therapy.

Asked if the results indicate that pregnant people trying to quit smoking should consider e-cigarettes, Wen emphasizes that the findings from the study need to be interpreted cautiously and must be confirmed in future randomized, controlled trials.

“The associations we have identified between use of e-cigarettes and abstinence during pregnancy might not be causal,” he says, “especially given substantial confounding factors, such as smoking intensity.”

He refers to the paper, which states, “If cigarette 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 after a discussion of the potential harms and benefits of using e-cigarettes during pregnancy compared with NRT or continued use of cigarettes.”

Additional coauthors are from the University of Washington, Roswell Park Comprehensive Cancer Center, and the University at Buffalo.

The National Institute on Drug Abuse and the National Institutes of Health supported the work.

Source: University at Buffalo