“Smoking tobacco is well known to contribute to cot death and underweight babies,” says private healthcare company BUPA (1).
“Smoking in pregnancy remains the leading preventable cause of neonatal and maternal mortality in the UK,” Professor Bauld (2).
The Smoking in Pregnancy Challenge Group says: “When a woman smokes during pregnancy or when she is exposed to secondhand smoke, oxygen to the baby is restricted making the babies heart work faster and exposing the baby to harmful toxins. As a result, exposure to smoke in pregnancy is responsible for an increased rate of stillbirths, miscarriages and birth defects.”
Is vaping a viable alternative to smoking during pregnancy?
Bupa provides a short answer: “As there are fewer ingredients in e-cigarettes, and at much lower levels, scientists agree vaping, or using other nicotine replacement therapies, is safer than smoking during pregnancy. However, although there’s no evidence to suggest nicotine harms unborn babies”.
As far back as 2015, experts such as Professor Linda Bauld were recognising that if vaping is a harm reduction approach for adult smokers, then it acts in the same way for pregnant women.
“The UK public health community issues a joint statement making clear that all the evidence suggests that e-cigarettes are significantly less harmful than smoking and current smokers should not be discouraged from using them. Our approach to e-cigarettes in pregnancy is build on this consensus,” she said.
“There is growing evidence of their potential promise to support smoking cessation in non-pregnant populations and both the Medicines Healthcare Regulatory Agency and the National Institute of Health and Care Excellence have made clear that these devices are less harmful than continued tobacco use.
Thus, despite the lack of data of safety in pregnancy, we can be relatively confident that if the choice is between continued smoking and use of an e-cigarette (‘vaping’) then vaping is the safer option”.
But vapes still contain nicotine – is this not dangerous?
During a webcast presentation, Bauld said: “We do not have evidence that nicotine use alone, separate from tobacco, is harmful in pregnancy.”
Professor Bauld referred to the SNAP trial that looked at the impact of traditional nicotine replacement products on quit rates and measurable outcomes for infants.
The trial found:
- Nicotine is broken down by the body faster during pregnancy
- The rate it’s broken down increases the urge to obtain more nicotine
- Women reported not being comfortable using NRT patches
- NRT use resulted in normal birth weights
- NRT use did not impact birth survival rates
- Monitoring infants for 2yrs showed NRT did not lead to detected impairments
“The large SNAP trial found that young children whose mothers had used nicotine replacement therapy after stopping smoking in pregnancy had normal development up to two years old”, Linda Bauld said.
Why can’t women just use NRT patches then?
“[The SNAP trial] provides the evidence to say that nicotine replacement therapy is safe to use during pregnancy. It might not work very well, which is important, but it’s safe,” Bauld explained.
So, nicotine is “safe” to use but patches, sprays and gum just don’t help mothers-to-be deal with nicotine urges.
What barriers prevent pregnant women switching to vaping?
Like with NRT, The Smoking in Pregnancy Challenge Group reported that pregnant women say they are concerned about e-cig safety and nicotine dependence and think there is a social stigma around vaping during pregnancy.
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