Reproductive Medicine & IVF

The Health Implications of Vaping While Pregnant

E-cigarettes are increasingly popular, but emerging research suggests pregnancy and vaping is a combination that may put the health of a fetus at risk.

Vaping is on the rise among women of reproductive age; the unpredictable effects of vaping and electronic cigarette use make this trend a growing public health concern. In a study published in Preventive Medicine in 2017 that sampled pregnant women across the United States, researchers found that 28.5 percent of current smokers and 4.9 percent of all participants used e-cigarettes during pregnancy.

Despite limited representative data on e-cigarette use during pregnancy, our understanding of the implications vaping might have on reproductive health is growing. Emerging research in mouse models on vaping while pregnant suggests the habit may affect implantation, stunt the growth of female offspring and jeopardize the health of a pregnancy. Clinicians are in a powerful position to educate young people and pregnant patients about the potential harm of vaping on maternal and fetal health.

Vaping Trends and Warnings

The American Pregnancy Association estimates that 12 percent to 20 percent of pregnant women continue to smoke during pregnancy. Among those trying to kick the habit, one study found e-cigarette use was more common among pregnant smokers than the use of Food and Drug Administration-approved smoking cessation devices such as nicotine patches and nasal sprays — perhaps due to e-cigarettes' convenience and prominent advertisement as a healthier alternative to cigarettes.

Vaping devices work by heating a liquid solution, often containing nicotine, that generates an inhaled aerosol, or vapor. Vaping liquid is available in flavors ranging from traditional cigarette-like options such as menthol to varieties that mimic candy and fruit.

The health risks of smoking during pregnancy are well understood. Cigarette use during pregnancy is associated with complications that include preterm birth, premature rupture of membranes, low birth weight, placenta previa and placental abruption. Smoking can also contribute to subfertility.

Research suggests that e-cigarettes deliver far fewer carcinogens into the body than tobacco cigarettes. Still, the health effects of e-cigarettes are only beginning to be understood; for example, emerging data suggests vape users are at increased risk for asthma and chronic obstructive pulmonary disease (COPD).

According to the Centers for Disease Control and Prevention (CDC), about 5.4 million middle and high school students used e-cigarettes in 2019, up nearly 50 percent from the previous year. The National Institutes of Health noted that in 2018, increases in nicotine vaping among 10th and 12th graders were the largest on record in its 44-year history of tracking adolescent drug use via its Monitoring the Future Survey. While teen pregnancy rates have been decreasing, young people may become pregnant or attempt to conceive before the effects of vaping on fetal or maternal health are completely understood.

Can Vaping Harm Fertility?

To better understand the risks of vaping while pregnant or trying to conceive, a study published in the Journal of the Endocrine Society in 2019 looked at e-cigarette exposure in a mouse model. The authors found that vaping significantly delayed implantation of a fertilized embryo in the uterus, despite high levels of progesterone. They also discovered that e-cigarette use in pregnancy stunted the growth of female offspring, who weighed less than the control offspring by the 8.5 month mark.

A separate paper exploring pregnancy and vaping in a mouse model found increased markers of inflammation, oxidative stress and scarring in the kidneys of adult offspring exposed to e-cigarettes in utero. Research in Reproductive Toxicology found e-cigarette vapors caused placental dysfunction in a mouse model by significantly reducing trophoblast invasion, a crucial stage in the establishment of pregnancy. However, the authors were unable to pin the negative effect on nicotine alone, implicating an unknown mechanism in the vaping process and suggesting further investigation is needed.

Taken together, these limited findings on pregnancy and vaping suggest that e-cigarette use during pregnancy should be viewed with caution. More studies are necessary to deepen our understanding of the potential health risks of vaping on maternal and fetal health and to better educate patients.