Vaping Instead of Smoking: Is It Safer for Women Who Want to Have Children?

In 2018, when researchers learned that approximately 1 out of every 5 high school students reported using e-cigarettes in the last 30 days, the U.S. Surgeon General declared e-cigarette usage among youth to be an epidemic. Six years later, that epidemic hasn’t lessened. Those who were in their teens are now in their prime reproductive ages. And those who are pregnant and who “vape” may be putting their babies at risk.

For the generation of middle and high school students who have been taught that traditional tobacco smoking could lead to lung cancer, stroke, heart disease, chronic obstructive pulmonary disease (COPD), and asthma, e-cigarettes may seem like a safer way of being cool. Designed to look like pens, USB drives, and other household items, they’re easy to conceal, and unlike tobacco smoking, vaping leaves no lingering odors. The fruit and candy flavoring added by manufacturers makes e-cigarettes all the more appealing—and all the more addicting.

They can deliver the same amount of nicotine as a high-nicotine cigarette. An e-cigarette “pod,” which provides approximately 200 puffs, is roughly equivalent to a pack of cigarettes. Vaping is a tough habit to kick at any age—probably as tough as quitting smoking. Either way, it’s billed as a safer alternative, particularly for pregnant women. But is it?

We know that women who smoke can have more difficulty getting pregnant. When they do, their babies tend to experience poor intrauterine growth, preterm delivery, and low birth weight. They are also at increased risk for birth defects such as cleft lip and cleft palate, and during childhood they can develop long-term neurodevelopmental and behavioral problems, as well as chronic respiratory disease. Understandably, doctors counsel women who want to become pregnant and deliver healthy babies to stop smoking—period.

Abstinence can be extremely difficult, though, and so as many as 75% of women who smoke switch to e-cigarettes on learning they’re pregnant. That’s a sizeable proportion, although the actual number of pregnant vapers is hard to determine. Only around 5% report e-cigarette usage, largely due to the stigma surrounding any kind of smoking. And just as in high school, vaping can be hard to detect. 

Numbers aside, the question remains: Is it a safer alternative? Right now, the full effects of e-cigarette usage on pregnant women and their babies remains unknown. But recent animal research offers some clues.

Our studies have found that the maternal rat uterine arteries exposed to e-cigarette vaping develop abnormally and are smaller in size, less able to dilate, and deliver less blood to the fetuses. This decreased in blood flow most likely leads to decreased oxygen and other nutrient transfer to the fetuses, resulting in poor growth, which is further exacerbated postpartum, when maternal rats that are exposed to e-cigarette vaping produce less milk volume. As for the rat babies—they’re not just off to a poor start nutritionally; they can also develop structural and functional lung and heart abnormalities, as well as a host of other problems including adverse metabolic changes and increased inflammation.  

What does this mean for humans? We don’t know exactly. We need much more research to pin down the effects of vaping on mothers and babies. Still, the evidence we’ve gathered so far points to the fact that it is very likely to be risky to both, so for any smoker who wants to become pregnant or already is, the bottom line is this: e-cigarette usage is not a good idea. 

Alex Juusela, MD, MPH

Board-Certified OB/GYN

3^rd year Maternal-Fetal Medicine Fellow at Wayne State University