CDC Warns Against Peripartum Use of Vaping Products

Physicians Should Offer Smoking Cessation Strategies to These Patients

March 11, 2019, 03:01 pm News Staff – Among women in Oklahoma and Texas who reported recently having given birth in 2015, 7 percent reported using electronic vaping products (EVPs) at some point before, during or after pregnancy.

That's according to a CDC Morbidity and Mortality Weekly Report (MMWR) released March 1 that evaluated 2015 Pregnancy Risk Assessment Monitoring System (PRAMS) data from these two states.

Because EVPs (which include a diverse group of devices and e-cigarettes) typically contain nicotine, these findings reinforce the importance of physicians offering a clear reminder to expectant mothers that EVPs aren't safe for use during pregnancy.

In an email communication about the MMWR, the CDC said, "Health care providers can help women understand the impact of nicotine on fetal and infant health outcomes and offer counseling and proven cessation treatment to prevent use of all tobacco products, including EVPs."

Additional MMWR Findings

PRAMS is a state- and population-based surveillance system designed to monitor selected self-reported behaviors and experiences before, during and after pregnancy among women who have had a recent live birth.

The MMWR researchers chose to analyze data from the 2015 PRAMS for Oklahoma and Texas because those states specifically included supplementary questions about EVPs on their PRAMS questionnaire that year. The sample they analyzed included 3,277 women; 60 percent were from Oklahoma and 40 percent were from Texas.

Story Highlights

The CDC assessed EVP use before pregnancy (defined as more than three months before pregnancy) and around the time of pregnancy (defined as any time during the three months before pregnancy, the last three months of pregnancy or two to six months after delivery), as well as reasons given for EVP use, and any reported dual use of EVPs and cigarettes during those periods.

According to the MMWR, researchers found that the prevalence of EVP use was 10.4 percent before pregnancy and 7 percent around the time of pregnancy, including 1.4 percent during the last three months of pregnancy.

Among women who used EVPs during the last three months of pregnancy, 38.4 percent said they used EVPs containing nicotine and 26.4 percent were unsure of the device's nicotine content.

For women who reported using EVPs and cigarettes, the CDC said dual use prevalence was 38 percent in the three months before pregnancy, 7.7 percent during the last three months of pregnancy and 11.8 percent during the two to six months after delivery.

The MMWR also noted that the most frequently reported reasons for EVP use around the time of pregnancy were curiosity (54 percent), the belief that EVPs might help with quitting or reducing cigarette smoking (45.2 percent), and the perception that harm to the mother would be reduced compared with cigarette smoking (45.2 percent).

Offering Alternatives to EVPs

The CDC said that although the U.S. Preventive Services Task Force has determined that current evidence is insufficient to recommend EVPs for tobacco cessation among adults (including pregnant women), many women still report using these products in their attempts to quit smoking cigarettes around the time of pregnancy.

"Barrier-free smoking cessation strategies with established effectiveness and safety need to be made available to all pregnant women," the MMWR said. "Behavioral intervention is a first-line treatment to help pregnant women quit smoking."

"In addition, Food and Drug Administration-recommended pharmacotherapy products (including nicotine replacement therapy) can be considered during pregnancy with close supervision of a clinician; these products don't contain the other harmful substances that have been found in the aerosol emitted from EVPs," the MMWR noted.

The report acknowledged, however, that variation in coverage provided by both public and private health insurers may inhibit access to effective treatment, a sentiment the AAFP laid out in an April 10, 2018, letter to the FDA.(3 page PDF)

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