E-cigarettes may help more pregnant women stop smoking than nicotine patches and are just as safe, the results of a UK study suggest.
As part of a randomised controlled trial, published in Nature Medicine on 16 May 2022, 1,140 pregnant smokers recruited from 24 hospital sites across England and Scotland were assigned to one of two groups and either given e-cigarettes or nicotine patches to assist with smoking cessation.
Researchers found that quit rates, as proven by saliva tests taken at the end of pregnancy, were similar between the groups. However, they noted that some participants in the group who had been randomly assigned to use patches had actually stopped smoking with the additional help of e-cigarettes during the study.
After reanalysing the data to take account of this, quit rates using e-cigarettes were found to be higher at 6.8% compared with 3.6% when patches were used.
Researchers suggested the quit rates were low across both groups owing to COVID-19 and poor responses to requests for samples, with only around half of those who self-reported that they had stopped smoking providing saliva for validation.
In contrast, self-reported abstinence from smoking at the end of pregnancy was 19.8% in the e-cigarette group compared with 9.7% in the nicotine patch group.
Researchers also found that 34% of the women in the e-cigarette group and 6% in the patch group were using their products at the end of pregnancy.
However, anecdotal evidence from follow-up phone calls suggested that some participants stopped using e-cigarettes and start smoking again because of a widely reported outbreak of lung disease in young vapers in the US during the study.
Birth outcomes and adverse effects were found to be largely similar among the two groups, with the exception of low birth weight, which was less common in those who were allocated to e-cigarettes, at 9.8% compared with 14.8% in the patch group.
Overall, e-cigarettes were more likely to be used by the pregnant women and to be used for longer periods than nicotine patches, the researchers said.
However, they also noted that almost 30% of the participants did not set a target quit date and only 40% and 23% used their products for at least four weeks in the e-cigarette and patch arms of the study, respectively.
Study lead Professor Peter Hajek, director of the Health and Lifestyle Research Unit at Queen Mary University of London, said: “While it is best for pregnant smokers to stop smoking without continuing to use nicotine, if this is difficult, e-cigarettes can help smokers quit and are as safe as nicotine patches.
“Many stop smoking services are already using e-cigarettes as an option for smokers generally. Such use can now be adopted in stop-smoking services for pregnant women as well.”
Christina Nurmahi, women and newborn care group lead pharmacist at University Hospital Southampton NHS Foundation Trust, said, in general, the greater harm from smoking is caused by the additional toxins found in cigarettes, aside from nicotine.
“Despite the lack of conclusive safety data with e-cigarettes, anything that helps women to stop smoking during pregnancy is better than actual cigarettes and certainly warrants further investigation.”
The National Institute for Health and Care Excellence recommended in 2021 that healthcare professionals, including pharmacists, should offer advice on e-cigarettes to help people stop smoking, after reviewing evidence that they were similarly effective to other approaches.
The Medicines and Healthcare products Regulatory Agency also paved the way for licensed e-cigarettes to be prescribed on the NHS, after a change to their guidance, but The Pharmaceutical Journal reported in April 2022 that as yet there have been no applications.