By: Alice Little Caldwell, MD, MPH, IBCLC, FAAP
It is proven and well known that smoking cigarettes during pregnancy is dangerous to the mother and baby’s health. But, do you also know e-cigarette use during pregnancy and breastfeeding is risky? E-cigarettes―also known as e-hookah, e-pens, vape pens, or tanks―are NOT a safe way to quit smoking during pregnancy either.
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In this article, the American Academy of Pediatrics answers frequently asked questions about e-cigarette use during pregnancy and breastfeeding.
While the number of people who smoke traditional cigarettes has declined in recent years, the growing popularity of e-cigarettes threatens to undo this progress―and risk babies’ exposure to harmful chemicals from smoking.
E-cigarettes are battery-operated cigarettes that turn chemicals, including nicotine, into a vapor, which is then inhaled. Nicotine is addictive and can damage a developing baby’s brain and lungs. E-cigarettes may also contain other substances that are harmful to a developing baby, like heavy metals, flavorings, and cancer-causing chemicals.
Is it ok to use e-cigarettes or JUUL to help me quit smoking if I’m pregnant?
No. E-cigarettes or JUUL are not yet regulated nor approved by the FDA as a way to quit smoking. They both contain significant amounts of nicotine and are NOT safer. There are more effective and safer ways to quit smoking when you are pregnant, including:
While tobacco companies advertise that e-cigs can help users quit smoking traditional cigarettes, don’t be fooled by the marketing claims. The U.S. Preventive Task Force (USPTF) recently concluded that “current evidence is insufficient to recommend electronic nicotine delivery systems (e-cigs) for tobacco cessation in adults, including pregnant women.”
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The USPTF recommends behavioral therapies such as counseling as most likely to be successful for pregnant women to stop smoking.
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If you are having a hard time quitting during pregnancy on your own, or with counseling, you may consider nicotine replacement therapy (NRT). FDA-approved forms of NRT include nicotine gum, patches, inhalers, nasal spray, and lozenges. It is important to talk with your doctor before using NRT so you understand the risks of using them during pregnancy. These should only be used under the close supervision of a physician.
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Cessation tablets, such as Zyban and Chantix, are NOT recommended during pregnancy.
Are e-cigarettes safe to use while pregnant?
No, e-cigs are NOT safe to use while pregnant. Tobacco companies advertise e-cigs as safe alternatives to traditional cigarettes, since they don’t release the same chemicals as burning tobacco smoke. However, e-cig vapor or aerosol still contains many other harmful substances. Also, due to the lack of regulation, the chemical compounds in e-cigarettes can vary between brands.
According to the Centers for Disease Control and Prevention (CDC), substances found in e-cig vapor include:
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ultrafine particles that can be inhaled deep into the lungs.
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flavoring like diacetyl, a chemical linked to a serious, irreversible lung disease called obliterative bronchiolitis.
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so-called volatile organic compounds, or gases emitted into the air that may have adverse health effects.
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cancer-causing chemicals such as nitrosamines, formaldehyde, and propylene glycol (a solvent used in anti-freeze).
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heavy metals, including nickel, tin and lead.
E-cigarette vapor can also contain a significant amount of addictive nicotine. For example, each “pod” of e-juice for JUUL brand e-cigarettes has as much nicotine as a pack of 20 regular cigarettes.
Are nicotine-free e-cigarettes safe during pregnancy?
No. According to the CDC, even some e-cigarettes advertised as nicotine-free still contain nicotine. One Australian study found that six out of 10 e-liquids advertised as “nicotine-free” actually did contain the chemical. Some samples tested were also found to contain 2-chlorophenol, a toxic substance that’s used in insecticides.
What are the effects of nicotine on a developing fetus and newborn baby?
Research on the effects of vaping on fetuses and newborns has lagged behind the quick rise in e-cigarette use.
Much of what we do know comes from studies of nicotine in tobacco products and smoking, which shows that nicotine is harmful and increases the risk of:
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miscarriage and complications during pregnancy.
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premature birth.
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low birthweight.
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abnormal brain development.
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abnormal lung function and lower respiratory infections such as bronchitis and pneumonia.
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chronic ear infections.
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sudden infant death syndrome (SIDS).
Stress, Smoking & New Parenthood
After the baby is born, many women who were able to quit or cut down on their smoking during pregnancy, gradually return to smoking or e-cigarette usage. This may be related to some of the stress that can come with new parenthood and falling back into old patterns of behavior. Be prepared for these challenges and have a plan to remain smoke and e-cigarette free!
Does nicotine from e-cigarettes get into breastmilk?
Yes. Inhaled nicotine enters a mother’s blood through her lungs, and then easily passes into breastmilk. Research shows that nicotine in a mother’s breastmilk can affect infant sleep patterns―raising the risk for blood sugar and thyroid problems that can lead children to become overweight. Nicotine is also thought to decrease milk supply in nursing mothers, possibly by lowering levels of the breastmilk-stimulating hormone prolactin.
If I can’t stop vaping or using e-cigarettes, should I still breastfeed?
Don’t stop breastfeeding if you smoke. Breastfeeding is good for your baby, so it’s better to do it than not, even if you’re still smoking.
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Because of the many benefits breastfeeding has for infants and moms, the American Academy of Pediatrics and the American College of Obstetrics and Gynecologists recommend breastfeeding even if the mother continues to use e-cigarettes.
If it’s not the right time for you to quit, make a plan to reduce your baby’s exposure to cigarette smoke:
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Don’t smoke while you’re feeding your baby. He or she will inhale your smoke or could get burned by the e-cigarette.
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Don’t smoke or vape near your baby. If possible, smoke outside. Make your house and car smoke-free to keep your baby away from secondhand smoke.
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After vaping, change your clothes, and wash your hands before holding your baby.
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Nurse your baby before, rather than after, vaping. Your body will have more time to clear the nicotine from breast milk.
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Don’t give up trying to quit. It often takes smokers several attempts to succeed.
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Text message programs, like SmokefreeMOM. This text message program gives 24/7 support to pregnant women. Enter your child’s due date to receive customized messages that match where you are in your pregnancy. Then, choose your goal of the program: to quit smoking or receive messages on smoking and health. You have the option to receive support even if you’re not yet ready to quit permanently. Sign up online or text MOM to 222888 to join now.
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Join the Smokefree Women Facebook page. Women who have quit, or are trying to quit, offer one another advice and inspiration.
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Additional Information:
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Marijuana Use During Pregnancy & Breastfeeding
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E-Cigarettes and Similar Devices (AAP Policy Statement)
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Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke (AAP Policy Statement)
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Smoking Cessation During Pregnancy (ACOG)
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Electronic Cigarettes and Pregnancy (March of Dimes)
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Breastfeeding: Tobacco and E-cigarettes (CDC)
About Dr. Caldwell:
Alice Little Caldwell, MD, MPH, IBCLC, FAAP, a pediatrician and lactation consultant, is an Associate Professor of Pediatrics at the Medical College of Georgia and Director of the Newborn Nursery at Augusta University Medical Center. Within the American Academy of Pediatrics, she is a member of both the Section on Breastfeeding and the Section on Tobacco Control.
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