Last week U.K. researchers published a study providing more evidence of the harm-reduction potential of nicotine containing e‑cigarettes—this time for pregnant women who smoke tobacco.
The randomized controlled trial, begun in 2019, included 1,140 participants from 24 UK hospitals. Pregnant women who smoked were placed on either nicotine patches or refillable nicotine e‑cigarettes to replace tobacco. The researchers found both replacement methods to have an equal safety profile. However, low birth weight was less frequent among the e‑cigarette arm of the study compared to the nicotine patch arm. At the end of the pregnancy, 10.7 percent of those who vaped remained abstinent from tobacco cigarettes, compared to 5.6 percent who used nicotine patches.
One of the study’s authors, Dr. Francesca Pesola, told the Guardian, “Using an e‑cigarette poses no greater risk to the mother or baby than nicotine patches, which are both better options than continuing to smoke throughout pregnancy.”
Citing one of the study’s limitations, the authors state:
Study results might also have been affected by an external event that occurred during the trial. In 2019 there was an outbreak of a lung disease in young vapers in the United States. This was termed ‘e‑cigarette or vaping product use-associated lung injury’ (EVALI) and although it was eventually traced to the addition of vitamin E acetate to local illicit marijuana products, it was widely reported internationally, including in the United Kingdom, as being related to nicotine vaping. Anecdotal evidence from follow-up calls suggested that the media warning about the dangers of e‑cigarettes use led some participants to stop using e‑cigarettes and return to smoking.
How unfortunate that the U.S. Centers for Disease Control chose to name the short-lived phenomenon “e‑cigarette or vaping product use-associated lung injury” (EVALI). This created the false assumption, promoted in the press, that vaping can cause deadly lung injury when, in fact, the culprit was—once again—drug prohibition: illicitly-made THC cartridges tainted with Vitamin E acetate. Soon after this became known, Washington and Colorado, where recreational cannabis is legal, banned the use of vitamin E acetate in the manufacture of any THC vaping cartridges by state‐based companies. By early 2020, as vapers, legal manufacturers, and clinicians became aware of the primary cause of EVALI, the outbreak abated and case reports have all but disappeared. The CDC stopped reporting on EVALI cases in February 2020. Unfortunately, the media scare frightened away many tobacco smokers from using e‑cigarettes to help them quit.
Unlike the U.S., U.K. public health officials recommend e‑cigarettes to help pregnant women give up smoking. In fact, Britain’s National Health Service website states:
If using an e‑cigarette helps you to stop smoking, it is much safer for you and your baby than continuing to smoke. Unlike nicotine replacement therapy (NRT), such as patches or gum, e‑cigarettes are not available on an NHS prescription. If you want to use an e‑cigarette, you can still get free expert help from a stop smoking adviser.
As I have written here, comparative effectiveness research shows nicotine-containing e‑cigarettes are more effective than nicotine patches, gum, or other replacements in achieving smoking cessation. Now we have evidence of how e‑cigarettes can benefit pregnant women who smoke. Meanwhile, the Food and Drug Administration continues slow-walking approvals of nicotine vaping products. And, to make matters worse, Congress recently extended FDA regulatory authority to include the regulation of synthetic nicotine products.
