The effects of prenatal cigarette and e-cigarette exposure on infant neurobehaviour: A comparison to a control group
Open accessAbstract
Background Infant neurobehaviour provides an insight into the development of the central nervous system during infancy, with behavioural abnormalities highlighting a cause for concern. Research has demonstrated that prenatal exposure to cigarettes leads to deficits within neurobehavioural development, along with negative birth outcomes detrimental to subsequent development. With the growing use of e-cigarettes amongst pregnant women, this study explores how prenatal e-cigarette exposure compares to prenatal cigarette exposure. Methods Eighty-three infants were involved in the study, either exposed prenatally to cigarettes or e-cigarettes or not exposed to either. Differences were assessed between these three groups for birth outcomes and scores on the Neonatal Behavioural Assessment Scale (NBAS) at one month of age. Findings Both cigarette and e-cigarette exposed infants had a significantly greater number of abnormal reflexes ( p = ·001; p = ·002). For both self-regulation and motor maturity, cigarette exposed infants performed significantly worse ( p = ·010; p = ·002), with e-cigarette exposed infants having decreased motor maturity ( p = ·036) abilities and marginally decreased for self-regulation ( p = ·057). Birth outcomes, namely birthweight, gestation and head circumference, did not differ for e-cigarette exposed infants compared with infants who were not prenatally exposed to nicotine. Cigarette exposed infants had a significantly lower birthweight ( p = ·021) and reduced head circumference ( p = ·008) in comparison to non-exposed infants. Interpretation To our knowledge, this is the first research study assessing a neurological outcome as a result of e-cigarette exposure. Findings of this have potentially important implications for public health policies regarding the safety and use of e-cigarettes throughout pregnancy. Funding This research was funded by a doctoral training partnership scholarship via the ESRC, ES/P000762/1.
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Two studies included a broad assessment of the use of nicotine products, including NRT.
“and two included a broad assessment of the use of nicotine products, including NRT [16, 40].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
The Methods state that women using NRT such as patches, gum, or inhalers were not eligible. The study assessed cigarette and e-cigarette exposure, rather than broadly assessing nicotine-product use including those NRT products. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredOne study observed similar infant head circumferences for infants of exclusive-vapers, exclusive-smokers and non-users.
“A further study observed similar infant head circumferences for infants of exclusive-vapers, exclusive-smokers and non-users [40].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
The Results report a significant difference in head circumference between cigarette-exposed and non-exposed infants: cigarette-exposed infants had smaller head circumferences (p = .008). Although e-cigarette-exposed infants did not differ significantly from either group, the paper does not report similar head circumferences across all three groups. (LLM, conf=0.92)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredEight studies reported that exclusive-vaping did not have a significantly different risk of preterm birth than non-use.
“To summarise the findings for PTB/GA, eight studies reported that exclusive-vaping did not have a significantly different risk than non-use [32, 40, 42, 46, 48, 50, 53, 54]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
The Discussion reports no significant difference in gestation at birth between e-cigarette-exposed and non-exposed infants. However, the Methods restricted the sample to infants born at term, so this study could not assess whether vaping changed the risk of preterm birth. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAll three studies reported similar levels of adverse neurological outcomes for exclusive-vaping and exclusive-smoking for reflex, motor maturity and self-regulation scores, relative frequency of mouth movements, and neuropathological brainstem outcomes.
“All three studies reported similar levels of adverse neurological outcomes for exclusive-vaping and exclusive-smoking, for the following outcomes: reflex, motor maturity and self-regulation scores [40], relative frequency of mouth movements [41], and neuropathological brainstem outcomes [44].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
The Results (page not provided) report similar reflex and motor-maturity scores for cigarette- and e-cigarette-exposed infants, with both groups performing significantly worse than unexposed infants. Self-regulation scores also did not differ significantly between the two exposed groups, but the e-cigarette group’s difference from unexposed infants was only marginal (p = .057). This source supports a similar pattern, but not a statistically established adverse self-regulation outcome for vaping. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThere was evidence of similar risk for exclusive-vaping and exclusive-smoking for NICU admissions, APGAR scores, hospital admissions, composite measures of adverse birth outcomes, and infant head circumferences.
“There was evidence of similar risk for exclusive-vaping and exclusive-smoking for NICU admissions and APGAR scores [46], hospital admissions [47], a composite measures of adverse birth outcomes [47] and infant head circumferences [40].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
Only the head-circumference clause is attributed to this paper; the other outcomes have separate citations. The Results report no significant head-circumference difference between e-cigarette- and cigarette-exposed infants, but only the cigarette-exposed group had a significantly reduced head circumference relative to unexposed infants. The Discussion therefore does not support interpreting the finding as similar risk from vaping and smoking. (LLM, conf=0.82)
Experimental — accuracy not yet measured
The finding for self-regulation needs to be treated with caution because the study simultaneously reported no heightened risk for self-regulation for exclusive-vaping compared with non-use.
“The finding for self-regulation needs to be treated with caution as they simultaneously reported no heightened risk for self-regulation for exclusive-vaping compared with non-use [40].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
The Results report no statistically significant difference in self-regulation between e-cigarette-exposed and non-exposed infants (p = .057), which supports the reason for caution. But the Discussion calls the difference marginal and notes a large effect size; the study does not establish that exclusive vaping carries no heightened risk. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe findings of similar risk of exclusive-smoking and exclusive-vaping for six studies, for some outcomes, need to be treated with caution, as they simultaneously found no significantly increased risk for exclusive-vaping compared with non-use.
“The findings of similar risk of exclusive-smoking and exclusive-vaping for six studies, for some outcomes, need to be treated with caution, as they simultaneously found no significantly increased risk for exclusive-vaping compared with non-use [40, 45–47, 50, 54].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredSix studies verified only smoking status.
“six verified only smoking status (33,34,37,40,41,44]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
Three studies considered the potential confounding effect of second-hand smoke exposure.
“Three studies considered the potential confounding effect of second-hand smoke exposure [16, 40, 45]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
Four studies reported no significant group differences for gestational age.
“and four reported no significant group differences for GA [40, 42, 46, 48].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
Among eight studies comparing exclusive-vaping and non-use, four reported similar birth weight.
“Among eight studies comparing exclusive-vaping and non-use, four reported similar BW [34, 40, 42, 46]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
One study observed that abnormal reflex scores were significantly higher for infants exposed to vaping compared with non-use.
“The first study observed that abnormal reflex scores were significantly higher and motor maturity scores were significantly lower for infants exposed to vaping [40].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
No significant differences in risk were found for exclusive-vaping versus non-use for self-regulation scores.
“No significant differences in risk were found for exclusive-vaping vs non-use for self-regulation scores [40] or relative frequency of mouth movements [41].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
One study observed that motor maturity scores were significantly lower for infants exposed to vaping compared with non-use.
“The first study observed that abnormal reflex scores were significantly higher and motor maturity scores were significantly lower for infants exposed to vaping [40].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
Four studies reported that exclusive-vaping did not have a significantly different risk of LBW/BW than non-use.
“In summary, for LBW/BW, four studies reported that exclusive-vaping did not have a significantly different risk than non-use [34, 40, 42, 46]”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
For three studies, the evidence is questionable because they simultaneously found no increased risk for exclusive-vaping compared with non-use and found similar risk for exclusive-vaping and exclusive-smoking, for the same outcomes.
“Notably, for three of these studies [40, 46, 47] the evidence is questionable as they simultaneously found no increased risk for exclusive-vaping compared with non-use and found similar risk for exclusive-vaping and exclusive-smoking, for the same outcomes.”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
Among three small studies of neurological outcomes, for at least one outcome, two reported higher risk for exclusive-vaping compared with non-use.
“In summary, among three small studies of neurological outcomes, for at least one outcome, two reported exclusive-vaping having a similar risk to non-use [40, 41] and two reported higher risk for exclusive-vaping [40, 44].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
These studies had the advantage that they all biochemically verified smoking status and two of the studies assessed the strength of nicotine in the vapes.
“These studies had the advantage that they all biochemically verified smoking status and two of the studies assessed the strength of nicotine in the vapes [40, 41].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
Among three small studies of neurological outcomes, for at least one outcome, two reported exclusive-vaping having a similar risk to non-use.
“In summary, among three small studies of neurological outcomes, for at least one outcome, two reported exclusive-vaping having a similar risk to non-use [40, 41] and two reported higher risk for exclusive-vaping [40, 44].”
From Vaping during pregnancy: a systematic review of health outcomes. (2024) · cites this paper as [40]
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Vaping during pregnancy: a systematic review of health outcomes.
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“Three studies considered the potential confounding effect of second-hand smoke exposure [16, 40, 45] and two included a broad assessment of the use of nicotine products, including NRT [16, 40].”
BackgroundMethodInfluentialUse of e-cigarettes in pregnancy: A systematic review of evidence published from 2020-2022
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- Authors
- Froggatt, S., Reissland, N., & Covey, J.
- Affiliations
- Durham University (GB)
- Corresponding author
- Froggatt, Suzanne
- Venue
- EClinicalMedicine
- Publisher
- Elsevier BV
- Published
- 2020-11
- Volume
- 28
- Pages
- 100602
- ISSN
- 2589-5370 (ISSN-L)
- PMC
- PMC7700948
- OpenAlex
- W3093355961
- Cited by
- 50
- References
- 8
- Citations by year
- 2026: 8 · 2025: 5 · 2024: 18 · 2023: 10 · 2022: 7 · 2021: 1 · 2020: 1
- FWCI
- 4.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- EClinicalMedicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Durham Research Online (Durham University) (acceptedVersion, other-oa)
- Durham Research Online (Durham University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Economic and Social Research Council
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Keywords
- neonatal reflexes, self-regulation, birth weight, head circumference, birth outcomes, nicotine, pregnancy
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