The use of electronic nicotine delivery systems during pregnancy and the reproductive outcomes: A systematic review of the literature
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University of Arkansas for Medical Sciences, Little Rock, United States
Parimal Chowdhury   

University of Arkansas for Medical Sciences, Little Rock, United States
Publish date: 2019-07-01
Tob. Induc. Dis. 2019;17(July):52
Use of electronic nicotine delivery systems (ENDS) among pregnant women is of great concern. To our knowledge the current literature provides conflicting views regarding the uncertainties of the effects of ENDS use during pregnancy on the health of the fetus.

We searched PubMed, CINAHL, and EMBASE, for the period 2007 to October 2017 for terms to identify publications on ENDS use during pregnancy and the reproductive outcomes. We updated the search for the period November 2017 to November 2018 using Ovid Medline. We obtained full text of articles and present a summary of the contents.

We found no studies of pregnant women exposed to ENDS use and its effect on their fetus or neonates. However, there is a growing body of experimental studies in animals that suggest that nicotine in ENDS alters DNA methylation, induces birth defects, reduces the birth weight, and affects the development of the heart and lungs of their offspring. A large population-based cohort study in the United States estimated that 5% of pregnant women were current ENDS users in 2014; most of them also smoked cigarettes. Surveys conducted among practitioners indicate that there is a need to screen and counsel pregnant women. Systematic reviews and meta-analysis of studies of women who used smokeless tobacco during pregnancy suggest that prenatal nicotine alone is a risk factor for low birth weight, premature delivery, and stillbirth.

There were no previous studies assessing the reproductive effects of ENDS use during pregnancy. However, prenatal exposure to nicotine is known to be harmful to the fetus and the pregnancy.

The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
This work was supported in part by a grant from the Arkansas Department of Health (ADH) to the University of Arkansas at Pine Bluff Minority Research Center (MRC) on Tobacco and Addictions, sub-awarded to V.M. Cardenas. This study was also supported by the UAMS Translational Research Institute (grant: UL1TR000039) through the National Institutes of Health (NIH) National Center for Research Resources and National Center for Advancing Translational Sciences.
Not commissioned; externally peer reviewed.
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