Smoking, Vaping, and Nicotine Exposure

Tobacco exposure in pregnancy is associated with an increased rate of adverse outcomes such as fetal growth restriction, preterm birth, placenta previa, abruptio placentae, congenital anomalies such as cleft lip/palate, and perinatal mortality. There are several mechanisms which have been identified and proposed to explain adverse obstetrical and fetal outcomes associated with maternal nicotine exposure through cigarette smoking, e‐cigarette use or other smokeless routes. Nicotine replacement therapies such as gum, lozenges, patches or inhalers provide a sustained, yet lower level of nicotine compared to cigarettes. Vaping or e‐cigarette aerosol may also expose the user to volatile organic compounds and heavy metals, in addition to the nicotine or other substances commonly delivered. Tobacco use not only impacts the health of the mother and fetus but carries over into the postnatal period. Many pregnant women can remain smoke free during their pregnancy but postnatal relapse rates are high.