Hi, I am Dr. Sunder. I am doing a presentation here on vaping and pregnancy for New Directions for Women. If you like this give me a thumbs up and please subscribe to our video as well.
I’m going to be talking to you all about vaping and pregnancy. As you all know, this has been a topic that has created a lot of controversy, but at the same time a lot of engagement because there has been a perception that the use of vaping is different from the use of nicotine in pregnancy. That it’s somehow less detrimental to use vaping as opposed to cigarettes.
I’m going to go through:
- What are the impacts of using nicotine overall (or what are called as nicotine like products)
- What are the myths and perceptions
- What is the research surrounding its use
- What are the risks and benefits
- What more needs to be done.
There is a very special relationship on this planet: mother and the baby. No one said this better than Sophia Loren, that a mother always has to think twice. Once for herself and once for her child. Though we might say that they are two different units, when we treat them we always have to think that whatever we do or don’t do will impact both the mother and the child.
What we also know from research from the National Institute of Health (NIH), the Society of Psychiatric Disorders of Childbirth, the Postpartum Support International and from multiple sources is that the use of drugs and alcohol (including nicotine) in pregnancy are associated with multiple problems, which we call also as reproductive toxicity. Now this slide gives you the perspective that there is an increased chance of the following issues in a newborn child when tobacco is used on a consistent basis:
- Birth defects
- Increased chance of stillbirth
- Increased chance of miscarriage
- Placental abruption
- Premature birth
- Low birth weight
- Problems with respiration
We end up with some problems that have deleterious effect on both the unborn child, the fetus, as well as the newborn. What we do know is at any given time about seven percent of women tend to use electronic cigarettes that contain nicotine and that the number seems to be less during the last three months of pregnancy, about 1.4 percent. The understanding is that somehow e-cigarette use during pregnancy is safe but as we can see, it is not, and we will show you some more data now in this particular study.
We are confirming what we have also just seen in the previous slide, which is that overall during the three months before pregnancy we have an increased amount of use. Then again during the two to six months after delivery there is an increased use of cigarettes, whereas the electronic cigarette use tends to be a little less now.
Another component that is important to recognize is the electronic nicotine delivery systems are a group of alternative tobacco products that were first introduced in about 2007. They include vaporizers, vape pens, hookah pens and electronic cigarettes. Now the solution in these electronic cigarettes is vaporized and it contains artificial flavorings (propylene glycol and glycerol). The perception is somehow e-cigarettes do not have the same exposure of nicotine as tobacco or cigarettes do, which is not true at all. The reality is that they are comparable. What we also now are understanding is that these other additives in e-cigarettes, we really have not studied the impact of these on a pregnant woman, on the fetus and after delivery.
Now the tricky part is that before 2016, electronic cigarettes were actually not tested, approved, or regulated by the FDA prior to their release in the market packaging, and advertising was not required to display the warning messages about health hazards (including pregnancy complications). Eventually the FDA ruled in 2016 that they are subject to the same requirements as cigarettes, cigars and other tobacco products, but then as you all can see the damage had already been done.
One myth that is circulated is that they are less harmful to the user than smoking traditional cigarettes, that they have fewer health effects and have several desirable properties. For example, that vaping is somehow a tool to quit using traditional cigarettes or it would help you to reduce the amount or number of cigarettes that you would smoke.
Actually, what has been found is that a majority of women who reported using either tobacco, or vapes during their pregnancy did not recall being screened by their providers regarding the use. It was assumed that somehow it was safe and that people would self-regulate.
What I would reiterate here is that the data tells us that vaping in fact is very similar in terms of the reproductive toxicity relative to the use of tobacco. What we do know is relative to other drugs (such as heroin and alcohol) an abrupt cessation of smoking cigarettes or vaping during pregnancy is not that harmful in the sense that you do not have the same maternal stress due to nicotine withdrawals that you might experience with for example abruptly stopping the use of heroin or methadone.
Now one of the things that American College of Obstetrics and Gynecology has done is to encourage everybody to call in 1 800 Quit Now, a helpline that allows women who are having difficulty to actually call and seek some help. If on the other hand, a woman decides that she’s unable to do it her own she can get in touch with trained providers and discuss the use of nicotine replacement therapy patches as well as medications, but each one of those has to be assessed on an individual basis because we don’t know for sure whether or not in a particular case nicotine replacement therapy presents risks to the fetus versus abruptly stopping it, versus the use of nicotine.
What we know is that many pregnant women also suffer from other conditions such as anxiety and depression, and oftentimes they are using nicotine or vaping to mask those symptoms. So untreated anxiety and depression is also a problem and treatment also has its risks and benefits. Of course as I mentioned, vaping and the use of nicotine also has its risks, so this has to be a risk benefit decision analysis that has to be taken in conjunction with a provider on an individual basis so what do we know about the e-cigarette effects on pregnancy perinatal and neonatal outcomes.
Nicotine is a molecule that can cross the placental barrier and it accumulates in large amounts in the placental tissues, amniotic fluid and in the blood of the unborn fetus. What we also know overall is that a fetus that is exposed to nicotine can actually suffer from having less circulation to it. Therefore this fetus can experience distress in utero.
Newborns can also sometimes suffer from anxiety and developmental studies have shown that nicotine use in pregnancy could be associated with other neurodevelopmental and behavioral problems in children, including attention deficits.
Because electronic cigarettes and vaping products are new, there is still continuing and ongoing research in animal studies; we know that the offspring can suffer because of continuous use of nicotine overall. On a positive note, we know that the FDA has started regulating vaping just in the same manner as cigarettes, so that’s the good news. The other good news is that you have smoking secession hotlines that are available to assist you because it is indeed difficult to stop that habit. Finally, we also know that there are multiple behavioral interventions that can assist pregnant women from stopping smoking and there are medications as well as other interventions that can assist.
At New Directions for Women, we assist all women in multiple ways to not only quit drugs and alcohol but also nicotine and vaping. Once again if you liked this video, please subscribe and give me a thumbs up. Thank you so much.