Michael Ussher, PhD, highlights the benefits of vaping over smoking in pregnancy

In a recent interview with Contemporary OB/GYN, Michael Ussher, PhD, professor at City St George's, University of London, discussed the serious adverse outcomes associated with smoking during pregnancy and explored potential alternatives such as vaping.

Smoking during pregnancy is identified as one of the leading causes of preventable adverse outcomes in the developed world. Ussher outlined a range of complications linked to maternal smoking, including miscarriage, stillbirth, premature birth, and low birth weight. Beyond birth outcomes, smoking during pregnancy can have long-term consequences for the child, such as increased risk of psychiatric disorders including attention deficit hyperactivity disorder, a higher likelihood of developing certain cancers, and a greater propensity to take up smoking in adolescence or adulthood. This creates a generational cycle of smoking-related harm.

While approximately 25% of pregnant women quit smoking on their own, many who continue are more heavily dependent smokers, often from lower socioeconomic backgrounds. For these individuals, quitting is particularly challenging, and professional support is usually necessary.

Ussher also addressed the topic of vaping as a possible harm-reduction strategy for pregnant smokers. Vaping eliminates the harmful combustion byproducts found in traditional tobacco smoke. Although both smoking and vaping involve nicotine, there is no strong evidence in humans that nicotine alone causes harm in pregnancy. However, he cautioned that some unknown toxins in e-cigarette vapor may still pose risks.

Studies suggest that vaping exposes users to significantly fewer toxins than smoking, but the long-term effects on fetal development remain unclear due to a lack of rigorous, well-controlled research. One challenge in studying vaping’s impact is that most pregnant women who vape either previously smoked or continue to smoke, making it difficult to isolate the effects of vaping alone.

In terms of clinical guidance, Ussher recommended behavioral support and nicotine replacement therapy such as patches as effective tools for helping pregnant women quit. He emphasized that financial incentives such as shopping vouchers have shown the most promise in encouraging smoking cessation, particularly in the United Kingdom. If other methods fail, switching to vaping may be a less harmful option compared to continued smoking, though more research is needed.

In conclusion, Ussher called for more comprehensive studies that accurately track exclusive smokers, vapers, and non-users from preconception through pregnancy to better understand the comparative risks and outcomes.

No relevant disclosures.

Reference

Ussher, M, Lewis S, Marczylo T, et al. Toxicant and nicotine exposure in pregnant smokers, vapers, and nicotine-replacement users: Cross-sectional study. Nicotine & Tobacco Research. 2025. doi:10.1093/ntr/ntaf103