All the way back in 2015, Linda was advocating switching, “despite the lack of data of safety in pregnancy,” because “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.”
Webinar, 11th January 2017.
In a Radio 4 interview in March, this year, Linda talked about the scientific safety trial looking at vaping during pregnancy, and said “1 in 5 pregnant women do not disclose that they are smoking. If smoking could be identified, more pregnant women could be offered support to quit. Smoking in pregnancy causes around 2,000 premature births and 5,000 miscarriages and 300 perinatal deaths per year. It can also contribute to poor health of the baby after being born. Moreover, smoking in pregnancy is the leading cause of preventable death for the mother herself.”
Bauld spoke to an audience at the Global Forum for Nicotine, in Poland. She began by highlighting the need to smoke within populations experiencing mental health concerns and how it impacted on those expecting a child: “Pregnant women are a hugely stigmatised group. Pregnant women, universally, despite the fact that they found smoking pleasurable, beneficial and enjoyable before, needed it to cope. There is a considerable degree of stigma.”
She highlighted the link between the amount the mother smokes and the level of toxins that can be detected within the fetal circulation (from as early as seven weeks). The more the mother smokes, the higher the levels of toxins the developing baby is subjected to.
“We DO NOT have evidence that nicotine use alone (separate from tobacco) is harmful in pregnancy.”
Bauld offered up evidence from the SNAP trial by way of supporting the idea that electronic cigarettes are a viable alternative to smoking during pregnancy. The SNAP trial looked at whether the nicotine replacement patch was effective or not for use in pregnancy. “They found that single product NRT wasn’t effective in supporting women to stop smoking.”
There were multiple reasons for this. Nicotine is broken down by the body faster during pregnancy, increasing the urge to obtain more. Also, women reported not being comfortable using NRT patches properly. But the important aspect of the trial, for Bauld, was the follow up after birth – survival with no impairment detected in two-year olds. “This provides the evidence to say that nicotine replacement therapy is safe to use during pregnancy” – not safer, safe. “It might not work very well, which is important, but it’s safe.”
Irrespective of the official stance, one third of pregnant women turning up at the Leicester quit service have already made the decision to switch to vaping – this compares to a 25% rate nationally.
A lot of women don’t like NRT, don’t find it useful, and don’t use it. Consequently, because there are babies dying now from tobacco-related complications, it is felt that it is impossible to sit around waiting for results from trials. Therefore the advice for women is they should consider switching to vaping if they can not stop smoking any other way.