Pregnant women who want to quit smoking can probably use e-cigarettes just as well as nicotine patches to support the quit attempt. This is apparent from a recent RCT (Nature Medicine 2022;28:958-64).
The researchers approached pregnant women who wanted to quit smoking. The women were 12-24 weeks pregnant. They were given either an e-cigarette or nicotine patches for up to 8 weeks. All participants were also called six times for supportive conversations. The primary outcome measure was the extent to which the participants had stopped from 2 weeks after their withdrawal date until the end of pregnancy. The participants had to tell themselves whether they had stopped and the researchers checked this by sending in saliva samples.
1,140 women from England and Scotland took part. On average, the women were 27 years old and about 16 weeks pregnant, and they smoked 10 cigarettes a day. At the end of the pregnancy, 196 women said they had stopped smoking. In 108 of these women this could be checked by means of saliva measurements of cotinine, anabasine and carbon monoxide. As many women stopped with e-cigarette support as with nicotine patches (39 vs. 25 women; 6.8 vs. 4.4%; relative risk (RR): 1.55; 95% CI: 0.95-2, 53). However, especially women who were assigned nicotine patches more often also used e-cigarettes.
When the researchers redone the analysis with only the women who used the product they were assigned to, more women were found to have stopped using e-cigarette support than nicotine patches (6.8 vs. 3.6% successfully quit; RR : 1.93; 95% CI: 1.14-3.26). The researchers also studied various pregnancy outcomes. Strikingly, low birth weight (< 2500 g) was more common in women using nicotine patches (9.6 in e-cigarettes vs. 14.8% in nicotine patches; RR: 0.65; 95% CI: 0.47- 0.90).
The authors conclude that e-cigarettes are no less safe than nicotine patches for pregnant women and may even be more effective. There is as yet no data on the effects of e-cigarettes on the further development of children.