Birth Defects Insights: Vaping During Pregnancy: Lesser of Two Evils or Wolf in Sheep’s Clothing?

Birth Defects Insights

Vaping During Pregnancy: Lesser of Two Evils or Wolf in Sheep’s Clothing?

By John Rogers, PhD, Teratology Society Past President iStock_vaping_300px.jpg

“County May Restrict Vaping,” “Vaping Burns Hole In Dad's LUNGS After E-Cigarette Spits Molten Nicotine Into His Throat,” and, perhaps one of the most disturbing, “Lab Tests Reveal Popular E-Cigarette Liquids Contain Harmful Chemicals.” These are just a few of the many headlines associated with vaping, otherwise known as electronic cigarette, or e-cigarette, use. 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.[1] 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.[2] 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 Gynecologists [4] 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.

With so many questions and not many answers, clearly it’s time to kick this issue in the “butt,” examine it closely, and light the way for healthier pregnancies and society in general.

Scientists interested or are already involved in research related to topics mentioned in this blog are encouraged to join the Teratology Society, the premier source for cutting-edge research and authoritative information related to birth defects and developmentally-mediated disorders. Members include those specializing in cell and molecular biology, developmental biology and toxicology, reproduction and endocrinology, epidemiology, nutritional biochemistry, and genetics, as well as the clinical disciplines of prenatal medicine, pediatrics, obstetrics, neonatology, medical genetics, and teratogen risk counseling. In addition, it publishes the scientific journal, Birth Defects Research.  Learn more at

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About The Author

John M. Rogers, PhD, has been a Teratology Society member since 1982 and is a past president. He is director of the Toxicity Assessment Division at the United States Environmental Protection Agency. His areas of expertise include developmental biology and toxicology, embryo/fetal physiology, epigenetics, maternal-fetal interactions, mechanisms of teratogenesis, maternal nutrition, and the developmental origins of health and disease.

[1] Brian A. King, Roshni Patel, Kimberly Nguyen, and Shanta R. Dube. “Trends in Awareness and Use of Electronic Cigarettes among U.S. Adults, 2010-2013.” Nicotine & Tobacco Research. First published online September 19, 2014, doi:10.1093/ntr/ntu191

[2] Mark, Katrina S. MD; et al. “Knowledge, Attitudes, and Practice of Electronic Cigarette Use Among Pregnant Women.” Journal of Addiction Medicine: July/August 2015 - Volume 9 - Issue 4 - p 266–272

[3] Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement Ann Intern Med 2009; 150:551-555

[4] American College of Obstetricians and Gynecologists. Smoking cessation during pregnancy. Committee Opinion No. 471, November 2010, Reaffirmed 2015.


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