The Allen Carr website (that sells its cold turkey approach) talks about “harmful chemicals” in electronic cigarettes, that nicotine “can damage the baby’s brain and is a risk to both the mother’s lungs”, and that “current evidence is insufficient to recommend electronic nicotine delivery systems (e-cigs) for tobacco cessation”.
The truth is that the issue isn’t this black and white.
What damage does smoking do?
“Smoking tobacco is well known to contribute to cot death and underweight babies,” says private healthcare company BUPA (1).
“Smoking in pregnancy remains the leading preventable cause of neonatal and maternal mortality in the UK,” Professor Bauld (2).
The Smoking in Pregnancy Challenge Group says: “When a woman smokes during pregnancy or when she is exposed to secondhand smoke, oxygen to the baby is restricted making the babies heart work faster and exposing the baby to harmful toxins. As a result, exposure to smoke in pregnancy is responsible for an increased rate of stillbirths, miscarriages and birth defects.”
Is vaping a viable alternative to smoking during pregnancy?
Bupa provides a short answer: “As there are fewer ingredients in e-cigarettes, and at much lower levels, scientists agree vaping, or using other nicotine replacement therapies, is safer than smoking during pregnancy. However, although there’s no evidence to suggest nicotine harms unborn babies”.
As far back as 2015, experts such as Professor Linda Bauld were recognising that if vaping is a harm reduction approach for adult smokers, then it acts in the same way for pregnant women.
“The UK public health community issues a joint statement making clear that all the evidence suggests that e-cigarettes are significantly less harmful than smoking and current smokers should not be discouraged from using them. Our approach to e-cigarettes in pregnancy is build on this consensus,” she said.
“There is growing evidence of their potential promise to support smoking cessation in non-pregnant populations and both the Medicines Healthcare Regulatory Agency and the National Institute of Health and Care Excellence have made clear that these devices are less harmful than continued tobacco use.
Thus, despite the lack of data of safety in pregnancy, we can be relatively confident that if the choice is between continued smoking and use of an e-cigarette (‘vaping’) then vaping is the safer option”.
But vapes still contain nicotine – is this not dangerous?
During a webcast presentation, Bauld said: “We do not have evidence that nicotine use alone, separate from tobacco, is harmful in pregnancy.”
Professor Bauld referred to the SNAP trial that looked at the impact of traditional nicotine replacement products on quit rates and measurable outcomes for infants.
The trial found:
- Nicotine is broken down by the body faster during pregnancy
- The rate it’s broken down increases the urge to obtain more nicotine
- Women reported not being comfortable using NRT patches
- NRT use resulted in normal birth weights
- NRT use did not impact birth survival rates
- Monitoring infants for 2yrs showed NRT did not lead to detected impairments
“The large SNAP trial found that young children whose mothers had used nicotine replacement therapy after stopping smoking in pregnancy had normal development up to two years old”, Linda Bauld said.
Why can’t women just use NRT patches then?
“[The SNAP trial] provides the evidence to say that nicotine replacement therapy is safe to use during pregnancy. It might not work very well, which is important, but it’s safe,” Bauld explained.
So, nicotine is “safe” to use but patches, sprays and gum just don’t help mothers-to-be deal with nicotine urges.
What is the evidence and advice for switching to vaping for pregnant women?
Within the UK, there is no higher authority than The Smoking in Pregnancy Challenge Group. This group is made up of members from the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists, the Royal College of Paediatrics and Child Health, the voluntary sector and university researchers.
From its 2021 report (3), the Group writes that it is essential “to ensure that pregnant women are supported to use e-cigarettes if that is their preferred way to quit.”
It warns that there is “a widespread misconception” about nicotine being perpetrated by the likes of Allen Carr’s pay-to-quit programme and others. It says that health professionals are best placed to counter this misinformation with facts, and that “e-cigarettes may be an important part of the mix of support” for pregnant women.
- “Smokers are more likely to quit successfully if they are supported to consistently access enough nicotine to help manage their cravings during their quit attempt”
- “Nicotine is relatively harmless on its own”
- “A recent Cochrane review of the efficacy and safety of NRT [and therefore vaping] during pregnancy found no evidence that NRT during pregnancy is harmful”
- “According to the findings of a recent Cochrane review, nicotine-containing e-cigarettes are approximately 70% more effective in supporting smokers to quit successfully than NRT”
- “Evidence from adult smokers in general suggests that they are likely to be significantly less harmful to a pregnant woman and her baby than continuing to smoke”
What barriers prevent pregnant women switching to vaping?
Like with NRT, The Smoking in Pregnancy Challenge Group reported that pregnant women say they are concerned about e-cig safety and nicotine dependence and think there is a social stigma around vaping during pregnancy.
Is The Smoking in Pregnancy Challenge Group updating this position?
A randomised control trial (RCT) looking at the safety and efficacy of e-cigs vs patches in helping pregnant smokers quit is due to report in mid-2021.
What should I do?
While pointing out mistakes in a seriously flawed study, Professor John Britton commented: “It does not … change current advice to pregnant women who smoke, which is to quit all nicotine use if possible but at the very least, stop smoking tobacco.”
If you can quit, quit – but if you can’t then use NRT products or switch to vaping.
- Is it safe to vape when I’m pregnant? - https://www.bupa.co.uk/newsroom/ourviews/is-vaping-harmful
- Are e-cigarettes safe to use in pregnancy? - https://www.cancerpreventionscotland.org.uk/newsletter/e-cigarettes-pregnancy/
- Use of electronic cigarettes before, during and after pregnancy - https://smokefreeaction.org.uk/wp-content/uploads/2019/08/2019-Challenge-Group-ecigs-briefing-FINAL.pdf