E-Cigarettes and Reproductive Risks

By Tarah Damask. Medically reviewed by Tom Iarocci, MD. May 7th 2016

Electronic cigarettes, or e-cigs, are commonly praised as a safer alternative to conventional cigarettes, but with limited research and a list of potentially harmful ingredients, they may take a toll on your reproductive health.

“Unfortunately,” says obstetrician Shannon M. Clark, OB/GYN and associate professor of Maternal-Fetal Medicine at the University of Texas Medical Branch at Galveston, “there is not much data on e-cigs in pregnancy.” Just scratching the surface of this issue, however, is limited yet significant toxicology research that points to e-cigs’ potential adverse effects on adults and in-utero development.  

Conception Problems

Although a variety of factors may affect reproductive health, researchers have identified particular ingredients in e-cigarettes that could potentially interfere with conception. In addition to nicotine, traces of toxins, have been found in e-cigs.

While concerns about vaping and fertility may immediately evoke thoughts of women’s health, nicotine and cotinine (a breakdown product of nicotine) have been implicated in problems with sperm motility, at least in the laboratory. Studies suggest nicotine may also cause decreased sperm count, as well as poor sperm function, but the bulk of the research has been done in cigarette smokers, not men who use e-cigs.

Nicotine use by women could potentially affect a couple’s ability to conceive. Conventional smoking has been linked to a greater risk of irregular menstrual cycles, ectopic pregnancy, spontaneous abortion and delayed conception.

In addition, nine of the toxins found in e-cigarettes are listed on California’s Prop 65, a list of chemicals known to cause reproductive problems, among other health issues, such as cancer. While the presence of these substances is of concern, the health impact of these chemicals in the concentrations found in e-cigs is not yet known. Given the known risks of tobacco smoke and potential risks of e-cigs, avoiding all nicotine-containing products may be the best plan for those trying to conceive..

Developmental Problems Before and After Birth

The question of whether switching from conventional cigarettes to e-cigarettes is a safer choice during pregnancy does not yield a simple answer. Removing carcinogenic tobacco from the equation improves a baby’s chances for healthy development, as well as the mother’s health. However, “safer” and “safe” are not identical labels. Choosing to use nicotine in any form may lead to potential developmental problems, affecting your baby before and after birth.

Nicotine, alone, easily crosses the placenta and binds receptors in the developing baby’s nervous system. Pregnant women are advised to completely abstain from all forms of nicotine for the entire pregnancy. Nicotine causes cell death and abnormalities during cell replication. Nicotine may also cause restricted blood flow to the placenta, which reduces necessary oxygen for healthy growth, including brain development.

Though specific birth defects associated with e-cigarette use are still under study, nicotine on its own may impact the development of a baby’s nervous system, potentially creating problems that could display themselves from birth all the way through adolescence and adulthood.

Parents-to-be should also take into consideration that nicotine is a drug to which the fetus may become addicted. Researchers at the Women & Infants Hospital of Rhode Island found that newborns exposed in utero to the nicotine in tobacco smoke were more excitable, abnormally tense, rigid and stressed. The study goes so far as to compare a baby’s withdrawal experience from nicotine with crack cocaine and heroin.

Another common side effect of smoking conventional cigarettes is low birth weight. Clark explains that though studies are limited, hypothetically, nicotine may cause growth restriction, saying, “The mass of the placenta is less when you smoke, with heavy to moderate smokers. It first effects placental development, which directly affects the growth of the fetus.”

Given that e-cigarette research is still underway, she asserts that she would feel compelled to closely follow a woman during pregnancy, even if she were using only e-cigarettes, just to make sure the mother and baby maintain good health. Clark further puts e-cigarettes during pregnancy into perspective, saying, “It’s always beneficial to stop smoking. If I had the choice between e-cigarettes, gum and patches, I would recommend gum or patches.”

The Dangers of E-Cigarette Poisoning  

One of the major risks of using e-cigarettes during pregnancy is the extreme toxicity of liquid nicotine in e-juice. Since the introduction of e-cigarettes, poisoning events have risen dramatically. Simply spilling e-juice on one’s skin may lead to severe side effects to the mother’s health, and that may potentially cause harm to an unborn fetus. (Though nausea and vomiting are among the common side effects associated with minimal exposure, excessive exposure to e-juice can be fatal.)

While data specific to e-cigarettes is still new and limited, all e-cigarettes containing nicotine pose a potential threat to the physical and behavioral development of your baby. Women looking for a safe alternative to conventional smoking during pregnancy will find that the only truly safe option is to quit the use of nicotine in any form. 

Next Steps

  • If you are having difficulty conceiving, or have just conceived, your safest method for avoiding complications is the complete cessation of nicotine use, including e-cigarettes.
  • Although nicotine and other chemicals in e-cigarettes may play a role in your reproductive health, visit your doctor to determine the basis for any reproductive concerns.
  • If you are pregnant, visit your ob/gyn regularly and be sure to discuss smoking and any nicotine replacement solutions.
  • Consider counseling or support groups, such as Smokefree Journey at SmokeFree.gov for additional support if you choose to quit nicotine.
  • Avoid secondhand vapor if you are pregnant. As Dr. Clark puts it, “In any situation when you can stay away from secondhand smoke, regardless of where it’s coming from, I would advise against it. Even secondhand vapor.” 

Sources

Clark, S., MD, Ob/Gyn and assistant professor of maternal-fetal medicine at the University of Texas Medical Branch. http://www.utmb.edu/obgyn/MeetFaculty.htm. Interviewed June 2014.
Wickstrom R., MD, “Effects of Nicotine During Pregnancy: Human and Experimental Evidence.” Karolinska Institutet, Sweden. September 2007. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656811/. Accessed June 2014.
American Academy of Pediatrics. “American Academy of Pediatrics Welcomes New FDA Proposed Rule on E-Cigarettes and Tobacco, Urges Stronger Action to Protect Children and Prevent Child Poisonings.” April 2014.
Zuckerman B. “Drug-Exposed Infants: Understanding the Medical Risk.” The future of Children, Princeton. 1991; 1(1). http://www.princeton.edu/futureofchildren/publications/journals/article/index.xml?journalid=69&articleid=498&sectionid=3387. Accessed June 2014.
Chung W., MD, PhD. “Teratogens and Their Effects.” Columbia University. http://www.columbia.edu/itc/hs/medical/humandev/2004/Chpt23-Teratogens.pdf. Accessed June 2014.
King County Public Health. “E-Cigarettes: What Should You Know?” Updated June 2014. http://www.kingcounty.gov/healthservices/health.aspx. Accessed June 2014.
University of Pennsylvania Perelman School of Medicine. “Nicotine Use.” http://www.med.upenn.edu/womenswellness/nicotine.html. Accessed June 2014.
New York University Langone Medical Center. “Erectile Dysfunction.” http://urology.med.nyu.edu/patient-care-information/conditions-we-treat/erectile-dysfunction. Accessed June 2014.
Brown University. “Nicotine Changes Newborn Behavior in Ways Similar to Heroin and Crack.” https://www.brown.edu/Administration/News_Bureau/2002-03/02-143.html. Accessed June 2014.
Glantz S., PhD. “Nine Chemicals Identified So Far in E-Cig Vapor That Are on the California Prop 65 List of Carcinogens and Reproductive Toxins.” Center for Tobacco Control Research and Education, University of California, San Francisco. July 2013. http://www.tobacco.ucsf.edu/9-chemicals-identified-so-far-e-cig-vapor-are-california-prop-65-list-carcinogens-and-reproductive-t. Accessed June 2014.
Baker L. “Nicotine Affects Sperm Adversely; Creates Changes that Reduce Fertility Potential, UB Research Finds.” January 2003. The State University of New York, University at Buffalo. http://www.buffalo.edu/news/releases/2003/01/6042.html. Accessed June 2014. 

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