During pregnancy, you’ll do anything to protect your little one. That means if you smoked before you conceived, you might have switched from conventional cigarettes to e-cigarettes because you heard they were harmless. Or, if you're a non-smoker, you might have wondered whether secondhand vapor from electronic cigarettes affects your baby.

While there's still questions that need to be answered about vaping and pregnancy, here's what expectant moms need to know.

What are e-cigarettes?

E-cigarettes come in many shapes and sizes: regular cigarettes, cigars, pipes, pens, pocket flashlights, small screwdrivers or USB memory sticks. And the terminology is just as varied — you may hear them called e-cigs, cigalikes, vape pens, personalized vaporizers or mechanical mods.

Whatever the shape or name, all are devices that deliver nicotine in a vapor (aerosol) instead of the tobacco smoke of a traditional cigarette.

With most e-cigarettes, a heating component in the cartridge warms up the liquid, which releases a vapor, and it is then inhaled and exhaled (hence why it's known as "vaping" instead of smoking). The "liquid," known as e-liquid, is a blend of chemicals that can be flavored or unflavored, and it can also come in varying levels of nicotine — which is why some people claim it allows smokers to graduate down to a lower level and eventually give up nicotine completely.

Are e-cigarettes safer than regular cigarettes?

The Centers for Disease Control and Prevention (CDC) and a 2016 Surgeon General report say that e-cigarettes are not safe for pregnant women, but because vaping has a potential benefit to smokers who are not pregnant, researchers are still conducting studies.[1]

These products are difficult to study: No researcher would willingly put an expecting mom potentially in harm's way in the name of research. What's more, there are hundreds of e-cigarette brands and thousands of e-liquid flavors, and they just recently began to be regulated by the U.S. Food and Drug Administration (FDA).

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That means that up until the summer of 2016, it was impossible to know what ingredients each maker was putting into its e-cigarettes. And vaping products are relatively new in the U.S., so there isn't enough research to determine what health issues they might cause in the short- or long-term.[2]

Here's what is known: Tobacco smoke from conventional cigarettes contains a mix of more than 7,000 chemicals, of which many are toxic or cancer-causing. E-cigarettes, on the other hand, emit fewer toxins and chemicals. A March 2017 study published in the Annals of Internal Medicine found that users of e-cigarettes, compared to conventional cigarette smokers, had lower levels of measured carcinogens and toxins compared to those who smoked cigarettes.[3] The reduction in risk was only found in those who stopped smoking cigarettes entirely, however.

But e-cigarette vapor definitely isn't harmless water vapor. The liquids used in e-cigarettes are typically made up of propylene glycol, vegetable glycerin, nicotine and flavoring chemicals. And some research has shown that when this liquid is heated at a high voltage (some vaping products allow the user to determine how low or high the voltage to produce more or less vapor), other chemicals are formed, and some of them, like formaldehyde, cause cancer.

A 2014 review published by the FDA also reported that the level of nicotine listed on the labels of e-cigarette cartridges and refill solutions is often significantly different from what's actually in the product. And potentially harmful chemicals (besides nicotine) were found in the cartridges, refill solutions and aerosols of e-cigarettes.

What's more, the FDA and the CDC are currently looking into cases in which vaping products were associated severe respiratory illness. “E-cigarette product use associated with lung injury” (or EVALI) is an acute and often severe respiratory illness, first reported in 2019, that is linked to inhalation of aerosolized substances from e-cigarettes. The majority of cases were related to inhalation of tetrahydrocannabinol (THC), but many cases were associated solely with inhaled nicotine. Research is still ongoing in regards to the pulmonary, as well as systemic risks, of these products.

The American Academy of Pediatrics (AAP), which represents the nation's pediatricians, warns that any exposure to e-cigarettes, including secondhand exposure, may be dangerous for children and teens.[4] That's why the group, as well as the American Medical Association (AMA), recommended the FDA regulate e-cigarettes the same as other tobacco products — meaning taxing e-cigarettes; increasing the nationwide age to purchase tobacco products (including e-cigarettes) to 21; and implementing bans on public smoking, advertising to children and teens, online sales of e-cigarettes, and all flavors of e-liquid.

Is vaping dangerous when you're pregnant?

Smoking during pregnancy can be harmful to your baby both before and after birth — which is why many groups, including the AMA, AAP and the American College of Obstetricians and Gynecologists (ACOG), which represents American OB-GYNs, urge moms to avoid lighting up at all during pregnancy.

That goes for conventional cigarettes as well as e-cigarettes, since vaping still exposes your baby to nicotine and other potentially harmful substances.

Because e-cigarettes do contain nicotine, experts are concerned that they could also increase the risk for:

After birth, children of mothers who smoked cigarettes during pregnancy are at higher risk of: 

  • Sudden Infant Death Syndrome (SIDS)
  • Asthma
  • Colic
  • Development of chronic conditions like attention deficit hyperactivity disorder (ADHD)

Should you be worried about exposure to secondhand e-cigarette smoke during pregnancy?

Even if you aren't using e-cigarettes, they could still affect you and your unborn child. A study in the journal Nicotine & Tobacco Research found that e-cigarettes emit significant amounts of nicotine. That means if you're nearby when someone is vaping an e-cigarette, you could be exposed to secondhand nicotine. In addition, since the aerosol can contain other potentially harmful chemicals, you'd be exposed to those, too.

For now, the effects of secondhand e-cigarette vapor aren't fully known. However, it's clear that secondhand exposure to tobacco cigarettes is definitely associated with some serious health issues, including heart disease, lung cancer and stroke.

Secondhand tobacco smoke also increases the risk of SIDS, a devastating event with little known risk factors. Maternal smoking during pregnancy, as well as exposure to secondhand smoke, are two of the most impactful risk factors and they are also the most preventable to help protect your baby. Secondhand smoke also causes health problems in children, such as more frequent illnesses, asthma and other breathing problems and ear infections. Being the child of a smoker also puts one at greater risk of being addicted to nicotine later in life.

Occasional exposure when you're out and about is unavoidable and not something you should fret over — it's repeated, frequent exposure that concerns experts. So to limit secondhand exposure to e-cigarette vapors, the AAP also recommended the government implement regulations to restrict smoking and tobacco products "in all workplaces, including bars, restaurants and health care facilities," as well as bans "in places where children live, learn and play, including sidewalks, recreational and sports facilities, entertainment venues, parks, schools and dormitories and multi-unit housing."

For now, though, no such nationwide regulations exist, and very few states have laws about when and where e-cigarettes can be used.

How to limit your exposure to cigarette smoke and e-cigarette vapor during pregnancy

Experts recommend limiting your exposure to cigarette smoke and e-cigarette vapor as much as possible during pregnancy. Here's how:

  • Avoid all nicotine products, including cigarettes, e-cigarettes and smokeless tobacco products like chewing tobacco
  • Make your home and car smoke-free
  • If you're not ready to quit smoking, smoke outside of the home with a separate layer of clothes and take them off before coming inside, since smoke products can linger on clothes
  • Ask people not to smoke around you
  • Make sure the places you visit (for instance, restaurants) are smoke-free
  • If you're visiting the home of someone you know smokes inside, try to socialize outside whenever possible

Safer ways to quit smoking

Although there are some claims that e-cigarettes can help people to stop smoking, the National Cancer Institute (NCI) says there's no evidence to prove this; e-cigarettes are not approved as a smoking cessation device. In fact, some studies have even shown that e-cigarettes make you significantly less likely to kick the habit.

The following safer alternatives are recommended for pregnant women:

Quit smoking

Giving up smoking can be a tough process — but the good news is many people do it successfully. To increase the likelihood that you'll be a former smoker:

  • Create a "quit plan" (check out NCI's Smokefree.gov for a personalized plan) that features your reasons for quitting (including the little darling growing inside of you), smoking triggers (so that you can avoid them) and strategies to help you deal with cravings.
  • Practice healthy habits: Keep busy, eat well and get enough sleep.
  • Find alternative ways to relieve stress — like exercise or deep breathing and meditation.
  • Miss the feeling of having something in your mouth? The American Cancer Society recommends keeping substitutes around that you can suck or chew on, like carrots, apples, raisins, hard candy or gum.

Get backup from other resources

You don't have to go through the struggle of quitting alone. In addition to help from family and friends, other support resources are available:

  • 1-800-QUIT-NOW hotline provides free one-one-one advice, help creating a quit plan, educational materials, information on FDA-approved cessation medications and referrals to local resources.
  • NCI’s Smokefree Women program, provides information and nonjudgmental support to pregnant women and mothers who are seeking information, advice or assistance in quitting any nicotine product, including e-cigarettes.
  • The NCI's text messaging service, SmokefreeMOM, provides support, information and tips to pregnant moms. The messages a mom-to-be receives depend on her due date and whether she's indicated she's not yet ready to stop or she wants to reduce or quit entirely.
  • Nicotine Anonymous, online support groups and local smoking cessation programs can be helpful.

Seek counseling

In addition to support lines and groups, many people find counseling from a doctor or other smoking cessation professional to be helpful — in fact, some research has found that moms who get counseling are 80 percent more likely to quit as well as less likely to pick up smoking again later. Ask your doctor about counseling, or check with local clinics or hospitals to see if they have counselors you can meet face-to-face.

Talk to your doctor about nicotine replacement therapy

If you have difficulty quitting on your own or with the help of counseling, your doctor may be able to help you quit by using nicotine replacement therapy (NRT).

NRT products include over-the-counter gums, patches and lozenges, as well as prescription nasal sprays and inhalers. These products should be used only under your doctor's care since they contain nicotine, which is best avoided during pregnancy. The nicotine-free medications Zyban and Chantix generally aren't recommended during pregnancy.

Experts strongly warn against using e-cigarettes when you're expecting. So although quitting may feel impossibly hard at times, kicking the nicotine habit during pregnancy is your safest bet for you and your baby, and there is support to help you make it happen. Remind yourself, especially when the going gets tough: You'll save lots of money, too — and what a reward it will be to put your hard-earned dollars toward a new stroller or your child's college fund.