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Health effects of using e-cigarettes.
Health effects of using e-cigarettes[1]
The figure shows the effects related to e-cigarette exposure during different vulnerable time periods.
The figure shows the effects related to e-cigarette exposure during different vulnerable time periods.[2]

No evidence has shown that e-cigarettes are safe for pregnant women to use, and no amount of nicotine is safe for pregnant women.[3] The potential health effects of using e-cigarettes during pregnancy remain largely uncertain.[4] E-cigarette use during pregnancy can be harmful to the fetus.[5] Many ingredients used in e-liquids have not been studied for their safety during pregnancy.[3]

Nicotine exposure during pregnancy is extremely harmful to the fetus.[6] Nicotine is also a health danger for pregnant people.[7] Prenatal nicotine exposure is associated with adverse effects on the growing fetus, including effects to normal growth of the endocrine, reproductive, respiratory, cardiovascular, and neurologic systems.[3] Nicotine has been found in breast milk.[8] Nicotine-free e-cigarette aerosols may cause harm to the fetus.[2] Cannabis use during pregnancy can be harmful to the baby's health.[9]

The belief that e-cigarettes are safer than traditional cigarettes could increase their use in pregnant women.[10] Concerns exist regarding pregnant women exposure to e-cigarette vapor through direct use or via exhaled vapor.[11] According to a 2017 review, the evidence that nicotine harms infant development justifies the need for public health initiatives to shield pregnant women from being exposed to nicotine.[12] Cannabis use during pregnancy is a serious public health problem.[13]

Overview

Relative safety

The following information is presented by the Centers for Disease Control and Prevention on e-cigarettes and pregnancy. It reads: Are e-cigarettes safer than regular cigarettes in pregnancy? Although the aerosol of e-cigarettes generally has fewer harmful substances than cigarette smoke, e-cigarettes and other products containing nicotine are not safe to use during pregnancy. Nicotine is a health danger for pregnant women and developing babies and can damage a developing baby’s brain and lungs. Also, some of the flavorings used in e-cigarettes may be harmful to a developing baby.
Information presented by the Centers for Disease Control and Prevention on e-cigarettes and pregnancy[14]

No evidence has shown that e-cigarettes are safe for pregnant women to use.[3] Some earlier research suggested that e-cigarette use is less risky to pregnancy outcomes, but more newer research refute these findings.[15] No amount of nicotine is safe for pregnant women.[3]

Although e-cigarettes are promoted as a "safer alternative" to traditional smoking, developmental research as of 2019 has raised concerns about the safety of inhaling nicotine through them, particularly during pregnancy.[4] Their use as a less harmful option to tobacco smoking during pregnancy remains unclear.[4] The potential dangers of using e-cigarettes during the early stages of pregnancy and organogenesis remain largely uncertain.[4] The long-term issues of e-cigarettes on both mother and unborn baby are unknown.[16] Research strongly indicates that certain chemicals found in e-cigarette aerosols, such as formaldehyde and acrolein, can trigger DNA damage and mutagenesis.[17] As a result, prolonged exposure to e-cigarette aerosols may heighten the risk of unfavorable reproductive outcomes.[18]

Overall health effects

E-cigarette use during pregnancy can be harmful to the fetus.[5] Some studies suggest that e-cigarette exposure not only has a negative impact on a woman's reproductive health but also on offspring when exposed to e-cigarette components in utero.[19] There was a trend towards lower fertility in male offspring and lower body weight and length in all offspring.[19] These findings suggest a hypothetical toxicity of e-cigarette exposure on an in utero developing fetus.[19] Neonatal exposure to e-cigarette induced altered lung growth, weight gain with significant and persistent behavioral alterations.[19] This raises the question of the potential impact of e-cigarettes on non-users that are passively exposed to the vapor during pregnancy.[19]

In what way the e-liquid ingredients could affect a fetus is unknown.[20] Many ingredients used in e-liquids have not been studied for their safety during pregnancy.[3] Studies examining the cytotoxicity of e-liquid flavorings found toxicity to be greater in undifferentiated embryonic stem cells relative to human pulmonary fibroblasts, raising potential concerns about exposure risks for pregnant women.[21] As the pregnancy progresses, the research indicates that the negative effects of nicotine exposure become more pronounced.[3]

Prenatal exposure to nicotine and other chemicals

Risks related to vaping during pregnancy
Risks related to vaping during pregnancy[22]

Scientific findings suggest that nicotine harms both maternal and fetal health during pregnancy, causing various unfavorable outcomes.[4] Nicotine exposure during pregnancy is extremely harmful to the fetus.[6] Nicotine seems to be more harmful to the growing fetus during the latter stage of pregnancy.[3] The rate of e-cigarette use among pregnant adolescents is unknown, but the effects of nicotine and the potential for harm by other e-cigarette toxicants indicate that the use of e-cigarettes is a fetal risk factor among pregnant adolescent girls.[23] Since e-cigarettes are not substantiated as cessation tools, may contain nicotine at inconsistent levels and added ingredients that are possibly harmful, to bear with e-cigarettes to be used among pregnant women to decrease smoking puts this group at considerable risk.[24]

In utero exposure to chemicals associated with vaping was detected in critical fetal organs such as the lungs, kidneys, brain, bladder, and heart.[25] Nicotine accumulates in the fetus because it goes through the placenta.[26] Nicotine has been found in placental tissue as early as seven weeks of embryonic gestation, and nicotine concentrations are higher in fetal fluids than in maternal fluids.[23] It also attaches to nicotinic acetylcholine receptors in the fetus brain.[12] When the brain is being developed, activating nicotinic acetylcholine receptors by nicotine can result in long-term developmental turmoil.[12]

Nicotine can induce a genotoxic effect in fetal cells.[27] Exposure of pregnant females to nicotine can lead to an altered inflammatory environment during gestation, which may have consequences on fetal hematopoiesis.[28] Moreover, it is yet unknown whether this is caused directly by nicotine in the fetal environment or by passage of maternal nicotine-induced inflammatory cytokines to the fetus during development.[28] It is unknown whether nicotine leads to transient or persisting alterations in developmental hematopoiesis.[28]

Although there is a scarcity of studies examining the birth results in mothers who vape nicotine while pregnant, a 2015 study in the UK found a noticeable increase in respiratory anomalies in mothers who used nicotine replacement products in contrast to mother who did not use these products.[29]

Nicotine is a health danger for pregnant people.[7] Prenatal nicotine exposure is associated with adverse effects on the growing fetus, including effects to normal growth of the endocrine, reproductive, respiratory, cardiovascular, and neurologic systems.[3] Prenatal nicotine exposure has been associated with dysregulation of catecholaminergic, serotonergic, and other neurotransmitter systems.[23] Prenatal nicotine exposure is associated with lower birth weights compared to other infants,[3] preterm birth,[30] stillbirth,[30], and sudden infant death syndrome.[3]

When birth weight is normal there still can be damage.[12] Nicotine may result in premature birth, miscarriage, fetal neurotoxicity, and fetal lung development issues.[31] Nicotine delivered by e-cigarettes during pregnancy can result in multiple adverse consequences, including sudden infant death syndrome, and could result in altered corpus callosum and deficits in auditory processing.[23] One study found that infants with prenatal exposure to e-cigarettes exhibited increased irritability than those whose mothers did not smoke at all during pregnancy.[8] Prenatal nicotine exposure is associated with asthma and wheezing which may continue into adulthood.[3]

Growing evidence indicates that inhaling e-cigarette aerosols while pregnant can potentially harm placental function, interfere with central metabolic regulation, induce cytotoxicity, DNA damage, and oxidative stress, as well as lead to behavioral and structural abnormalities.[4] Many of these negative developmental effects are also observed with non-nicotine e-cigarette aerosols, which suggests that nicotine may not be the only contributor to these effects.[4]

Prenatal non-nicotine effects

Nicotine-free e-cigarette aerosols may cause harm to the fetus.[2]

Health effects on brain development

There is an increasing amount of research on the negative effects of nicotine on prenatal brain development.[32] Prenatal nicotine exposure is associated with alterations to normal brain development.[3] During developmental stages such as gestation, the brain exhibits increased plasticity, which makes it more susceptible to the detrimental effects of nicotine use.[33]

A 2014 Surgeon General report found "that nicotine adversely affects maternal and fetal health during pregnancy, and that exposure to nicotine during fetal development has lasting adverse consequences for brain development."[34] The toxic effects identified with e-cigarette refill liquids on stem cells may be interpreted as embryonic death or birth defects.[10]

Health effects on infant lung function

There is growing evidence that exposure of pregnant women to e-cigarettes may impair placental function and may result in fetal structural abnormalities.[2] Specifically, this may cause physio-pathologic changes in the developing lung, which in turn may impair respiratory health later in life.[2]

Vaping during pregnancy resulted in a reduction in lung volume.[35] Vaping during pregnancy could impact lung pathophysiology as well as function in infants.[36]

Evidence from animal studies indicate that being exposed to second-hand vapor containing nicotine during pregnancy may impede fetal lung development.[37] In a 2020 study, the effects of cinnamon-flavor exposure in Balb/c pregnant mice and their offspring showed that preconception flavor exposure increases lung tissue fraction at birth compared to non-exposed groups, suggesting that cinnamaldehyde may be teratogenic.[38] Low amounts of aldehydes can still be a health concern among pregnant women.[39]

Several studies using murine models have demonstrated that both nicotine-containing and nicotine-free e-cigarette aerosols adversely affect offspring respiratory health by increasing susceptibility to pulmonary diseases later in life.[25] Additionally, transcriptomic analysis of fetal lung tissue showed substantial dysregulation in gene expression, indicating molecular alterations in response to prenatal vaping exposure.[25] Other preclinical studies have examined the effects of exposure to additives in nicotine-free e-cigarettes on postnatal neurological development in mice.[25] These investigations identified increased long-term anxiety-like behavior and impaired locomotor activity in offspring, especially following late gestational and prolonged exposure.[25] These findings are corroborated by in vitro studies demonstrating the neurotoxic potential of e-cigarette vapor constituents on fetal brain development.[25]

Nicotine metabolism

Nicotine metabolism is elevated in pregnant women compared to non-pregnant women, which heightens the risk of withdrawal symptoms.[40]

Other effects

Gestational age nicotine exposure is associated with many neurological deficits.[3] Prenatal exposure has been associated with obesity, diabetes, high cholesterol, and high blood pressure in minors.[41] Prenatal nicotine exposure in females may lead toward early menarche.[3] An infant was born with necrotizing enterocolitis due to e-cigarette use during pregnancy.[42] Animal models indicate that exposure to e-cigarette aerosol during critical developmental periods—especially in utero—can impair organ development and lead to organ damage.[43]

Breastfeeding

There is a lack of research on the use of e-cigarettes during breastfeeding.[8] For this reason, using e-cigarettes during breastfeeding is discouraged.[8] The consequences of vaping on infants feeding on breast milk is uncertain.[44] Nicotine has been found in breast milk.[8] Infant heart rate and blood pressure fluctuations are linked to higher nicotine levels in breast milk.[8]

It is discouraged for pregnant and breastfeeding females to substitute cigarettes with e-cigarettes.[44] It is also discouraged to use e-cigarettes while breastfeeding infants or young children.[44] There is concern for breastfeeding females using e-cigarettes, due to the lack of data on propylene glycol transferring to breast milk.[45]

Cannabis and its derivatives

Potential health effects of using cannabis during pregnancy

The US Food and Drug Administration strongly advises against the use of cannabidiol (CBD), tetrahydrocannabinol (THC), and cannabis in any form during pregnancy or while breastfeeding.[46] The Centers for Disease Control and Prevention advises against the use of cannabis while pregnant.[9]

Using cannabis during pregnancy may increase a person's risk for pregnancy complications.[9] Cannabis use during pregnancy can be harmful to the baby's health.[9] The chemicals in cannabis (in particular, THC) pass through your system to your baby and may harm your baby's development.[9] Some research shows that using cannabis while you are pregnant can cause health problems in newborns, including lower birth weight and abnormal neurological development.[9] The potential health effects of using CBD products during pregnancy are currently unknown.[9]

Cannabis use while pregnant and breastfeeding

Studies suggest that cannabis use by women during pregnancy could be linked to problems with attention, memory, problem-solving skills, and behavior in their children later in life.[9] The health effects of a breastfeeding woman's use of cannabis on their infant or baby are not yet fully known.[9] Chemicals from cannabis can be passed to a baby through breast milk.[9] THC is stored in body fat and is slowly released over time, meaning a baby could still be exposed even after a woman has stopped using cannabis.[9] Thus, the Centers for Disease Control and Prevention encourages women who are breastfeeding to avoid all cannabis use.[9]

Passive vaping

A 2024 case study investigating passive exposure to vaping during pregnancy demonstrated the transplacental transfer of several harmful substances, including glycerin, aluminum, chromium, nickel, copper, zinc, selenium, and lead, from the mother to the fetus via cord blood.[25]

The low parental perception of the risks connected to e-cigarette exposure for children throughout different vulnerability windows increases their susceptibility to harmful effects from passive vaping, including prenatal damage and post-natal respiratory effects, and increases the risk of vaping among adolescents.[2] Since the child's home is the primary source of exposure to tobacco smoke, addressing the issue of parental perception of the harmful effects of e-cigarette exposure in children is essential for promoting health, especially in more vulnerable children such as those with respiratory chronic diseases like asthma.[2]

Dual users

Using both (smoking and vaping) during pregnancy may result in higher exposure to nicotine.[47] Dual users (smoking and vaping) in pregnancy have higher odds of giving birth to a small-for-gestational-age child than with exclusive smoking of conventional cigarettes according to two 2019 studies and a 2020 study found higher incidence of birthweight (below 10th percentile) and a higher rate of admission to a neonatal intensive care unit in offspring of dual users than in offspring of exclusive smoking of conventional cigarettes.[48]

However, the latter study also found the same birthweight, Apgar score, and gestation at delivery in offspring of dual users as in offspring of exclusive smoking of conventional cigarettes, and another study in 2016 found that dual users had the same (elevated) risk of small-for-gestational-age and preterm birth as exclusive smoking of conventional cigarettes.[48] Furthermore, a very large cohort study in 2021 of young women found a lower but not significantly different fecundability ratio in dual users than in exclusive smoking of conventional cigarettes.[48]

Multigenerational effects

See also: Epigenetic effects of smoking
Figure 1.[49] Experimental Design to Analyze Effects of Developmental Nicotine Exposure (DNE) on Epigenetic Factors Over Two Generations[49] Nicotine-exposed female mice (F0) were mated with unexposed male mice. Epigenetic factors in certain brain areas of their first-generation (F1) and second-generation (F2) offspring were compared with those in F1 offspring of control mice not exposed to nicotine.[49] Red arrows indicate the animals studied.[49]
Figure 2.[49] Nicotine Exposure of Female Mice Alters Epigenetic Factors in First-Generation (F1) and Second-Generation (F2) Offspring[49] Epigenetic factor levels in F1 (left panel) and F2 (right panel) offspring of nicotine-exposed mice were compared with F1 offspring of control mice.[49] The color scale indicates the relative percent increase (green) or decrease (red) of each factor in each brain region. FCX = frontal cortex; STR = striatum; HIPP = hippocampus; *p<0.05; **p<0.01; ***p<0.001.[49]

In 2020, mice that were exposed to nicotine during early development and their offspring showed changes in the levels of epigenetic factors that regulate gene expression in certain brain regions.[49] The observed changes were consistent with altered patterns of epigenetic modifications seen in mice and humans with neurological and behavioral disorders.[49] Epigenetic changes can persist for generations after nicotine exposure.[49] It remains unclear how nicotine exposure elicits changes in epigenetic factor levels and how these changes are passed on across generations.[49]

Maternal smoking of traditional cigarettes and maternal vaping of e-cigarettes during pregnancy exposes the fetus to nicotine; developmental nicotine exposure (DNE) can harm the baby's brain development and has been linked to disorders such as attention deficit/hyperactivity disorder, autism, and schizophrenia in children.[49] Of particular concern, animal model studies of maternal and grandmaternal cigarette smoking or vaping nicotine show that DNE is associated with behavioral and neurological changes that can persist across multiple generations.[49]

A 2020 National Institute on Drug Abuse-funded study by Jordan M. Buck and colleagues at the University of Colorado has identified a mechanism that may be responsible for this intergenerational transmission.[49] The researchers focused on epigenetic changes—chemical modifications of the DNA and associated proteins that influence gene expression.[49] "Our findings imply that epigenetic perturbations may constitute a nexus for intergenerational transmission of DNE-induced neurodevelopmental deficits," says Buck.[49]

Nicotine exposure leads to epigenetic changes that affect lung function in future generations.[50] Vaping or the use of any nicotine-based product during pregnancy, or both during pregnancy and the breastfeeding postpartum period, causes the "concurrent exposure of three generations to nicotine."[51] Exposure to nicotine by fathers has a strong association with brain and behavioral changes across generations, which, in part, is due to modifications in the epigenome.[51]

Vaping cessation

There are resources available to help pregnant women quit using e-cigarettes (and tobacco cigarettes).[8] For example, one can consult a healthcare provider in regard to quitting.[8] One can also get cost-free advice, support, and referrals by calling the Smoker’s Quitline at 1-800-QUIT-NOW (1-800-784-8669) in the US.[8] Although Smoker’s Quitline primarily addresses tobacco cigarettes, they can also offer assistance for e-cigarettes, as both contain the addictive chemical nicotine.[8]

Since the majority of e-cigarettes, like Juul, contain nicotine, and considering the teratogenic effects of nicotine on the growing fetus, a 2020 review recommends it is best to refrain from using them while pregnant.[47]

E-liquids contain various substances whose safety for pregnant women has not been established.[3] A 2012 study examined a variety of refill e-liquids and determined that, with the exception of one flavor, all were toxic to human embryonic stem cells.[3] Due to these findings, a 2016 review concluded that it is inadvisable to endorse the use of e-cigarettes during pregnancy.[3]

Cannabis cessation

Although the prevalence of cannabis use disorder has gone up in the years leading up to 2023, research into treating this disorder during pregnancy remains limited.[13] Pregnant individuals dealing with substance use introduces unique challenges in accessing specialized care, including difficulties in finding services, a shortage of appropriate treatment options, and avoidance of care due to concerns associated with detection by health or law enforcement authorities.[13]

Smoking cessation

See also: Women and smoking

The US Preventive Services Task Force recommends that expecting mothers who smoke to use only behavioral interventions to quit smoking.[44] During pregnancy, behavioral interventions successfully help 15% of women who are unable to quit smoking on their own.[52] The other 85% may require additional intervention strategies.[52] The best time to quit smoking is before a women gets pregnant, but quitting at any time during pregnancy can help the baby get a better start on life.[53]

Epidemiology

Approximately 10% of all pregnancies involve exposure to nicotine.[3] The most widely used illegal drug used among pregnant females is cannabis.[54] Most studies found that a self-reported prevalence of cannabis use during pregnancy varied from 2% to 5%.[55]

Public perception

The belief that e-cigarettes are safer than traditional cigarettes could increase their use in pregnant women.[10]

Public health debate

Concerns exist regarding pregnant women exposure to e-cigarette vapor through direct use or via exhaled vapor.[11] According to a 2017 review, the evidence that nicotine harms infant development justifies the need for public health initiatives to shield pregnant women from being exposed to nicotine.[12] The extensive use of e-cigarettes or nicotine replacement products raises significant concerns, as these options are not entirely harmless and can lead to adverse health effects for mothers and their offspring.[33] Cannabis use during pregnancy is a serious public health problem.[13]

See also

References

  1. ↑ "Electronic Cigarettes – What are the health effects of using e-cigarettes?". Centers for Disease Control and Prevention. 22 February 2018.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Mescolo, Federica; Ferrante, Giuliana; La Grutta, Stefania (20 August 2021). "Effects of E-Cigarette Exposure on Prenatal Life and Childhood Respiratory Health: A Review of Current Evidence". Frontiers in Pediatrics. 9. doi:10.3389/fped.2021.711573. PMC 8430837. PMID 34513764.{{cite journal}}: CS1 maint: unflagged free DOI (link) This article incorporates text by Federica Mescolo, Giuliana Ferrante, and Stefania La Grutta available under the CC BY 4.0 license.
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 Holbrook, Bradley D. (June 2016). "The effects of nicotine on human fetal development". Birth Defects Research Part C: Embryo Today: Reviews. 108 (2): 181–192. doi:10.1002/bdrc.21128. ISSN 1542-975X. PMID 27297020.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Greene, Robert M.; Pisano, M. Michele (15 October 2019). "Developmental toxicity of e-cigarette aerosols". Birth Defects Research. 111 (17): 1294–1301. doi:10.1002/bdr2.1571. ISSN 2472-1727. PMID 31400084. S2CID 199518879.
  5. ↑ 5.0 5.1 "Electronic Nicotine Delivery Systems (ENDS), including E-cigarettes". New Zealand Ministry of Health. 14 October 2014. Archived from the original on 2015-05-11.
  6. ↑ 6.0 6.1 Kaur, J.; Rinkoo, A. V. (June 2015). "A call for an urgent ban on E-cigarettes in India--a race against time". Global Health Promotion. 22 (2): 71–74. doi:10.1177/1757975914537322. ISSN 1757-9759. PMID 24938513.
  7. ↑ 7.0 7.1 "Health Effects of Vaping". Centers for Disease Control and Prevention. 15 May 2024.Public Domain This article incorporates text from this source, which is in the public domain.
  8. ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 "E-cigarettes (Vaping)". Mother To Baby | Fact Sheets. Organization of Teratology Information Specialists (OTIS). July 2023. PMID 35951787.
  9. ↑ 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 9.10 9.11 "Cannabis and Pregnancy". Centers for Disease Control and Prevention. 31 January 2025.Public Domain This article incorporates text from this source, which is in the public domain.
  10. ↑ 10.0 10.1 10.2 Ebbert, Jon O.; Agunwamba, Amenah A.; Rutten, Lila J. (January 2015). "Counseling Patients on the Use of Electronic Cigarettes". Mayo Clinic Proceedings. 90 (1): 128–134. doi:10.1016/j.mayocp.2014.11.004. ISSN 0025-6196. PMID 25572196.
  11. ↑ 11.0 11.1 Grana, Rachel; Benowitz, Neal; Glantz, Stanton A. (13 May 2014). "E-Cigarettes: A Scientific Review". Circulation. 129 (19): 1972–1986. doi:10.1161/circulationaha.114.007667. PMC 4018182. PMID 24821826.
  12. ↑ 12.0 12.1 12.2 12.3 12.4 England, Lucinda J.; Aagaard, Kjersti; Bloch, Michele; Conway, Kevin; Cosgrove, Kelly; Grana, Rachel; Gould, Thomas J.; Hatsukami, Dorothy; Jensen, Frances; Kandel, Denise; Lanphear, Bruce; Leslie, Frances; Pauly, James R.; Neiderhiser, Jenae; Rubinstein, Mark; Slotkin, Theodore A.; Spindel, Eliot; Stroud, Laura; Wakschlag, Lauren (January 2017). "Developmental toxicity of nicotine: A transdisciplinary synthesis and implications for emerging tobacco products". Neuroscience & Biobehavioral Reviews. 72: 176–189. doi:10.1016/j.neubiorev.2016.11.013. ISSN 0149-7634. PMC 5965681. PMID 27890689.
  13. ↑ 13.0 13.1 13.2 13.3 Hayer, Sarena; Mandelbaum, Ava D.; Watch, Lester; Ryan, Kimberly S.; Hedges, Madeline A.; Manuzak, Jennifer A.; Easley, Charles A.; Schust, Danny J.; Lo, Jamie O. (July 2023). "Cannabis and Pregnancy: A Review". Obstetrical & Gynecological Survey. 78 (7): 411–428. doi:10.1097/OGX.0000000000001159. PMC 10372687. PMID 37480292.
  14. ↑ "E-Cigarettes and Pregnancy". Centers for Disease Control and Prevention. 15 May 2024.Public Domain This article incorporates text from this source, which is in the public domain.
  15. ↑ Ramlal, Meera; Van der Meer, Renske; Bendien, Sarah (March 2024). "Treatable Traits in Pregnant Women with Asthma". Respiration. 103 (4): 217–232. doi:10.1159/000536455. PMC 10997272. PMID 38471469.
  16. ↑ Suter, Melissa A.; Mastrobattista, Joan; Sachs, Maike; Aagaard, Kjersti (March 2015). "Is There Evidence for Potential Harm of Electronic Cigarette Use in Pregnancy?". Birth Defects Research Part A: Clinical and Molecular Teratology. 103 (3): 186–195. doi:10.1002/bdra.23333. ISSN 1542-0752. PMC 4830434. PMID 25366492.
  17. ↑ Public Health Consequences of E-Cigarettes 2018, p. 18, Summary.
  18. ↑ Public Health Consequences of E-Cigarettes 2018, p. 18–19, Summary.
  19. ↑ 19.0 19.1 19.2 19.3 19.4 Montjean, Debbie; Godin Pagé, Marie-Hélène; Bélanger, Marie-Claire; Benkhalifa, Moncef; Miron, Pierre (18 March 2023). "An Overview of E-Cigarette Impact on Reproductive Health". Life. 13 (3): 827. doi:10.3390/life13030827. PMID 36983982.{{cite journal}}: CS1 maint: unflagged free DOI (link) This article incorporates text by Debbie Montjean, Marie-Hélène Godin Pagé, Marie-Claire Bélanger, Moncef Benkhalifa, and Pierre Miron available under the CC BY 4.0 license.
  20. ↑ Siu, AL (22 September 2015). "Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement". Annals of Internal Medicine. 163 (8): 622–34. doi:10.7326/M15-2023. PMID 26389730.
  21. ↑ Franck, Caroline; Filion, Kristian B.; Kimmelman, Jonathan; Grad, Roland; Eisenberg, Mark J. (December 2016). "Ethical considerations of e-cigarette use for tobacco harm reduction". Respiratory Research. 17 (1): 53. doi:10.1186/s12931-016-0370-3. ISSN 1465-993X. PMC 4869264. PMID 27184265.{{cite journal}}: CS1 maint: unflagged free DOI (link) This article incorporates text by Caroline Franck, Kristian B. Filion, Jonathan Kimmelman, Roland Grad, and Mark J. Eisenberg available under the CC BY 4.0 license.
  22. ↑ Kapaya, Martha; D’Angelo, Denise V.; Tong, Van T.; England, Lucinda; Ruffo, Nan; Cox, Shanna; Warner, Lee; Bombard, Jennifer; Guthrie, Tanya; Lampkins, Ayesha; King, Brian A. (1 March 2019). "Use of Electronic Vapor Products Before, During, and After Pregnancy Among Women with a Recent Live Birth — Oklahoma and Texas, 2015". MMWR. Morbidity and Mortality Weekly Report. 68 (8): 189–194. doi:10.15585/mmwr.mm6808a1. PMC 6394383. PMID 30817748.
  23. ↑ 23.0 23.1 23.2 23.3 U.S. Department of Health and Human Services (22 November 2016). "E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General". Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Surgeon General of the United States. pp. 1–298.Public Domain This article incorporates text from this source, which is in the public domain.
  24. ↑ England, Lucinda J.; Bunnell, Rebecca E.; Pechacek, Terry F.; Tong, Van T.; McAfee, Tim A. (August 2015). "Nicotine and the Developing Human". American Journal of Preventive Medicine. 49 (2): 286–93. doi:10.1016/j.amepre.2015.01.015. ISSN 0749-3797. PMC 4594223. PMID 25794473.
  25. ↑ 25.0 25.1 25.2 25.3 25.4 25.5 25.6 Petrella, Francesco; Faverio, Paola; Cara, Andrea; Cassina, Enrico Mario; Libretti, Lidia; Torto, Sara Lo; Pirondini, Emanuele; Raveglia, Federico; Spinelli, Francesca; Tuoro, Antonio; Perger, Elisa; Luppi, Fabrizio (1 June 2025). "Clinical Impact of Vaping". Toxics. 13 (6): 470. doi:10.3390/toxics13060470. PMC 12197008. PMID 40559943.{{cite journal}}: CS1 maint: unflagged free DOI (link) This article incorporates text by Francesco Petrella, Paola Faverio, Andrea Cara, Enrico Mario Cassina, Lidia Libretti, Sara Lo Torto, Emanuele Pirondini, Federico Raveglia, Francesca Spinelli, Antonio Tuoro, Elisa Perger, and Fabrizio Luppi available under the CC BY 4.0 license.
  26. ↑ "Electronic Cigarettes – An Overview" (PDF). German Cancer Research Center. 2013.
  27. ↑ Schraufnagel, Dean E.; Blasi, Francesco; Drummond, M. Bradley; Lam, David C. L.; Latif, Ehsan; Rosen, Mark J.; Sansores, Raul; Van Zyl-Smit, Richard (15 September 2014). "Electronic Cigarettes. A Position Statement of the Forum of International Respiratory Societies". American Journal of Respiratory and Critical Care Medicine. 190 (6): 611–618. doi:10.1164/rccm.201407-1198PP. ISSN 1073-449X. PMID 25006874.
  28. ↑ 28.0 28.1 28.2 Cool, Taylor; Baena, Alessandra Rodriguez y; Forsberg, E. Camilla (30 December 2021). "Clearing the Haze: How Does Nicotine Affect Hematopoiesis before and after Birth?". Cancers. 14 (1): 184. doi:10.3390/cancers14010184. PMC 8750289. PMID 35008347.{{cite journal}}: CS1 maint: unflagged free DOI (link) This article incorporates text by Taylor Cool, Alessandra Rodriguez y Baena, and E. Camilla Forsberg available under the CC BY 4.0 license.
  29. ↑ McGrath-Morrow, Sharon A.; Gorzkowski, Julie; Groner, Judith A.; Rule, Ana M.; Wilson, Karen; Tanski, Susanne E.; Collaco, Joseph M.; Klein, Jonathan D. (1 March 2020). "The Effects of Nicotine on Development". Pediatrics. 145 (3): e20191346. doi:10.1542/peds.2019-1346. PMC 7049940. PMID 32047098.
  30. ↑ 30.0 30.1 Chapman 2015, p. 5.
  31. ↑ Drope, Jeffrey; Cahn, Zachary; Kennedy, Rosemary; Liber, Alex C.; Stoklosa, Michal; Henson, Rosemarie; Douglas, Clifford E.; Drope, Jacqui (November 2017). "Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of nicotine". CA: A Cancer Journal for Clinicians. 67 (6): 449–471. doi:10.3322/caac.21413. ISSN 0007-9235. PMID 28961314.
  32. ↑ Drummond, MB; Upson, D (February 2014). "Electronic cigarettes. Potential harms and benefits". Annals of the American Thoracic Society. 11 (2): 236–42. doi:10.1513/annalsats.201311-391fr. PMC 5469426. PMID 24575993.
  33. ↑ 33.0 33.1 Castro, Emily M.; Lotfipour, Shahrdad; Leslie, Frances M. (April 2023). "Nicotine on the developing brain". Pharmacological Research. 190: 106716. doi:10.1016/j.phrs.2023.106716. PMC 10392865. PMID 36868366.
  34. ↑ Brandon, T. H.; Goniewicz, M. L.; Hanna, N. H.; Hatsukami, D. K.; Herbst, R. S.; Hobin, J. A.; Ostroff, J. S.; Shields, P. G.; Toll, B. A.; Tyne, C. A.; Viswanath, K.; Warren, G. W. (1 February 2015). "Electronic Nicotine Delivery Systems: A Policy Statement from the American Association for Cancer Research and the American Society of Clinical Oncology". Clinical Cancer Research. 21 (3): 514–525. doi:10.1158/1078-0432.CCR-14-2544. ISSN 1078-0432. PMID 25573384.
  35. ↑ Huang, Shu-Jie; Xu, Yan-Ming; Lau, Andy T. Y. (June 2018). "Electronic cigarette: A recent update of its toxic effects on humans". Journal of Cellular Physiology. 233 (6): 4466–4478. doi:10.1002/jcp.26352. ISSN 0021-9541. PMID 29215738.
  36. ↑ McAlinden, Kielan Darcy; Eapen, Mathew Suji; Lu, Wenying; Sharma, Pawan; Sohal, Sukhwinder Singh (1 October 2020). "The rise of electronic nicotine delivery systems and the emergence of electronic-cigarette-driven disease". American Journal of Physiology-Lung Cellular and Molecular Physiology. 319 (4): L585 – L595. doi:10.1152/ajplung.00160.2020. ISSN 1040-0605. PMID 32726146.
  37. ↑ Chun, Lauren F; Moazed, Farzad; Calfee, Carolyn S; Matthay, Michael A.; Gotts, Jeffrey Earl (1 August 2017). "Pulmonary Toxicity of E-cigarettes". American Journal of Physiology. Lung Cellular and Molecular Physiology. 313 (2): L193 – L206. doi:10.1152/ajplung.00071.2017. ISSN 1040-0605. PMC 5582932. PMID 28522559.
  38. ↑ Effah, Felix; Taiwo, Benjamin; Baines, Deborah; Bailey, Alexis; Marczylo, Tim (3 October 2022). "Pulmonary effects of e-liquid flavors: a systematic review". Journal of Toxicology and Environmental Health, Part B. 25 (7): 343–371. doi:10.1080/10937404.2022.2124563. PMC 9590402. PMID 36154615. This article incorporates text by Felix Effah, Benjamin Taiwo, Deborah Baines, Alexis Bailey, and Tim Marczylo available under the CC BY 4.0 license.
  39. ↑ Qasim, Hanan; Karim, Zubair A.; Rivera, Jose O.; Khasawneh, Fadi T.; Alshbool, Fatima Z. (22 September 2017). "Impact of Electronic Cigarettes on the Cardiovascular System". Journal of the American Heart Association. 6 (9): e006353. doi:10.1161/JAHA.117.006353. ISSN 2047-9980. PMC 5634286. PMID 28855171.
  40. ↑ Nakamura, Aurélie; François, Olivier; Lepeule, Johanna (11 May 2021). "Epigenetic Alterations of Maternal Tobacco Smoking during Pregnancy: A Narrative Review". International Journal of Environmental Research and Public Health. 18 (10): 5083. doi:10.3390/ijerph18105083. PMC 8151244. PMID 34064931.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  41. ↑ "WHO Right to Call for E-Cigarette Regulation". World Lung Federation. 26 August 2014.
  42. ↑ Hua, My; Talbot, Prue (December 2016). "Potential health effects of electronic cigarettes: A systematic review of case reports". Preventive Medicine Reports. 4: 169–178. doi:10.1016/j.pmedr.2016.06.002. ISSN 2211-3355. PMC 4929082. PMID 27413679. This article incorporates text by My Hua and Prue Talbot available under the CC BY 4.0 license.
  43. ↑ Szumilas, Kamila; Szumilas, Paweł; Grzywacz, Anna; Wilk, Aleksandra (24 August 2020). "The Effects of E-Cigarette Vapor Components on the Morphology and Function of the Male and Female Reproductive Systems: A Systematic Review". International Journal of Environmental Research and Public Health. 17 (17): 6152. doi:10.3390/ijerph17176152. PMC 7504689. PMID 32847119.{{cite journal}}: CS1 maint: unflagged free DOI (link) This article incorporates text by Kamila Szumilas, Paweł Szumilas, Anna Grzywacz, and Aleksandra Wilk available under the CC BY 4.0 license.
  44. ↑ 44.0 44.1 44.2 44.3 Smith, L; Brar, K; Srinivasan, K; Enja, M; Lippmann, S (June 2016). "E-cigarettes: How "safe" are they?". J Fam Pract. 65 (6): 380–5. PMID 27474819.
  45. ↑ Bertholon, J.F.; Becquemin, M.H.; Annesi-Maesano, I.; Dautzenberg, B. (24 September 2013). "Electronic Cigarettes: A Short Review". Respiration. 86 (5): 433–8. doi:10.1159/000353253. ISSN 1423-0356. PMID 24080743.
  46. ↑ "What You Should Know About Using Cannabis, Including CBD, When Pregnant or Breastfeeding". United States Food and Drug Administration. 16 October 2019.Public Domain This article incorporates text from this source, which is in the public domain.
  47. ↑ 47.0 47.1 Breland, Alison; McCubbin, Andrea; Ashford, Kristin (15 October 2019). "Electronic nicotine delivery systems and pregnancy: Recent research on perceptions, cessation, and toxicant delivery". Birth Defects Research. 111 (17): 1284–1293. doi:10.1002/bdr2.1561. ISSN 2472-1727. PMC 7121906. PMID 31364280.
  48. ↑ 48.0 48.1 48.2 Pisinger, Charlotta; Rasmussen, Sofie K. Bergman (21 October 2022). "The Health Effects of Real-World Dual Use of Electronic and Conventional Cigarettes versus the Health Effects of Exclusive Smoking of Conventional Cigarettes: A Systematic Review". International Journal of Environmental Research and Public Health. 19 (20): 13687. doi:10.3390/ijerph192013687. PMC 9603628. PMID 36294263.{{cite journal}}: CS1 maint: unflagged free DOI (link) This article incorporates text by Charlotta Pisinger and Sofie K. Bergman Rasmussen available under the CC BY 4.0 license.
  49. ↑ 49.00 49.01 49.02 49.03 49.04 49.05 49.06 49.07 49.08 49.09 49.10 49.11 49.12 49.13 49.14 49.15 49.16 Tobin, Stacey C. (22 September 2021). "Developmental Nicotine Exposure in Mice Affects Epigenetic Factors in the Brain Across Multiple Generations". National Institute on Drug Abuse.Public Domain This article incorporates text from this source, which is in the public domain.
  50. ↑ Chatkin, José Miguel; Dullius, Cynthia Rocha (December 2016). "The management of asthmatic smokers". Asthma Research and Practice. 2 (1): 10. doi:10.1186/s40733-016-0025-7. ISSN 2054-7064. PMC 5142412. PMID 27965778.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  51. ↑ 51.0 51.1 Buck, Jordan M; Yu, Li; Knopik, Valerie S; Stitzel, Jerry A (14 September 2021). "DNA methylome perturbations: an epigenetic basis for the emergingly heritable neurodevelopmental abnormalities associated with maternal smoking and maternal nicotine exposure". Biology of Reproduction. 105 (3): 644–666. doi:10.1093/biolre/ioab138. PMC 8444709. PMID 34270696.
  52. ↑ 52.0 52.1 Baraona, L. Kim; Lovelace, Dawn; Daniels, Julie L.; McDaniel, Linda (May 2017). "Tobacco Harms, Nicotine Pharmacology, and Pharmacologic Tobacco Cessation Interventions for Women". Journal of Midwifery & Women's Health. 62 (3): 253–269. doi:10.1111/jmwh.12616. ISSN 1526-9523. PMID 28556464.
  53. ↑ "Smoking, Pregnancy, and Babies". Centers for Disease Control and Prevention. 13 October 2023.Public Domain This article incorporates text from this source, which is in the public domain.
  54. ↑ Badowski, S; Smith, G (February 2020). "Cannabis use during pregnancy and postpartum". Canadian family physician Medecin de famille canadien. 66 (2): 98–103. PMC 7021337. PMID 32060189.
  55. ↑ Agolli, Arjola; Agolli, Olsi; Chowdhury, Selia; Shet, Vallabh; Benitez, Johanna S. Canenguez; Bheemisetty, Niharika; Waleed, Madeeha Subhan (30 June 2022). "Increased cannabis use in pregnant women during COVID-19 pandemic". Discoveries. 10 (2): e148. doi:10.15190/d.2022.7. PMC 9748245. PMID 36530177. This article incorporates text by Arjola Agolli, Olsi Agolli, Selia Chowdhury, Vallabh Shet, Johanna S. Canenguez Benitez, Niharika Bheemisetty, and Madeeha Subhan Waleed available under the CC BY 4.0 license.

Bibliography

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