E-cigarette use during pregnancy increases risk for material and newborn problems

At a time when England is still encouraging pregnant women who smoke to switch to e-cigarettes, the evidence that e-cigarettes complicate pregnancy continues to grow. The recent meta-analysis “Associations between vaping during pregnancy and perinatal outcomes: A systematic review and meta-analysis” pooled the results of 25 studies published as of July 2024 and found about 50% increases in the odds of adverse material or infant outcomes, including low birth weight, preterm birth, and small for gestational age.

The authors limited themselves to results from women who just used e-cigarettes, excluding people who also smoked cigarettes (dual users) to avoid possible confounding of risks with smoking.

These results are consistent with animal data showing e-cigarette exposure to pregnant mice inhibits lung and skeletal development in developing fetuses just like cigarette smoking does.

E-cigarettes should not be promoted to pregnant people.

Here is the abstract:

Despite numerous studies linking prenatal vaping to adverse perinatal outcomes, a systematic assessment for critical comparison remains absent. To investigate these associations, we conducted a systematic search of studies assessing perinatal outcomes in mothers and/or neonates exposed to vaping during pregnancy compared to those in women without prenatal vaping exposure through MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, PROSPERO, and Google Scholar until July 5, 2024. We performed inverse-variance random-effects meta-analyses for maternal and neonatal outcomes of 23 studies with a total of 924,376 participants with 7552 reporting vaping-only use during pregnancy. Prenatal vaping was associated with 53 % higher odds of an adverse maternal outcome (OR: 1.53; 95 % CI: 1.27-1.85; I² = 80 %), particularly with decreased breastfeeding (OR: 0.53; 95 % CI: 0.38-0.72; I² = 45 %) and reduced prevalence of adequate prenatal care (OR: 0.69; 95 % CI: 0.56-0.86; I² = 82 %). Prenatal vaping was also associated with a similarly 53 % higher odds of an adverse neonatal outcome (OR: 1.53; 95 % CI: 1.34-1.76; I² = 45 %), such as low birth weight (OR: 1.56; 95 % CI: 1.28-1.93; I²: 15 %), preterm birth (OR: 1.49; 955 CI: 1.27-1.76; I²: 0 %), and small for gestational age (OR: 1.48; 955 CI: 1.16-1.89; I²: 70 %). This is the first comprehensive systematic review and meta-analysis demonstrating vaping during pregnancy as a risk factor for increased odds of both maternal and neonatal outcomes and underscores the urgency to address awareness and regulations of vaping and its potential harms to both humans and the environment. REGISTRATION: PROSPERO CRD42023446266.

The full citation is: Deprato A, Garud A, Azzolina D, Murgia N, Davenport MH, Kaul P, Lacy P, Moitra S. Associations between vaping during pregnancy and perinatal outcomes: A systematic review and meta-analysis. J Hazard Mater. 2025 Mar 15;486:137028. doi: 10.1016/j.jhazmat.2024.137028. Epub 2024 Dec 26. PMID: 39754882. It is available here.