Friday, October 18, 2019

Vape-Related Lung Illness Is Concerning, Especially for Pregnant Mothers and Babies

By Ankita Brahmaroutu
Medical Student, Texas A&M University College of Medicine
Texas Medical Association Board of Trustees Student Representative

The headlines are everywhere: A mysterious pulmonary illness due to using electronic vapor products (EVPs) has killed 33 people in the United States, with nearly 1,500 cases reported so far. Texas health officials have identified 119 cases of severe lung disease in people who have reported using e-cigarettes or vaping products, including one death, and the state is investigating 21 other possible cases. Even more frightening is that physicians and other medical professionals do not yet know the causes, nature, and effects of this illness. Some doctors are calling it a lipoid pneumonia (a rare condition that occurs when fat particles enter the lungs), while others are comparing it to a chemical burn. The Centers for Disease Control and Prevention (CDC) has called the vaping-related illness EVALI, which stands for “e-cigarette, or vaping, product use-associated lung injury.” 

Vaping, using e-cigarettes, or JUULing, among other names, all reference the inhalation of liquefied nicotine or nicotine salts. Nicotine is highly addictive. 

There are a lot of unknowns to this vaping-related outbreak, but as a response, federal and state legislators are ramping up efforts to crack down on vaping companies and the use of their products. At my own school, Texas A&M University, officials recently announced a ban of e-cigarettes on all of its campuses.

While a sharp focus has centered on vaping among teenagers, we can’t forget that this epidemic affects all demographics, including one that might surprise you: women who are pregnant or who are hoping to become pregnant.

Harmful to Pregnant Women … and Eventually, Babies, Too
Expectant women who use EVPs are at risk of hypertension, gastroesophageal reflux (i.e., heartburn, or when stomach acid backs up into the esophagus), and many other disorders that tend to worsen during pregnancy. The dangers of using these products aren’t limited to mothers-to-be; babies are affected, too. Early nicotine exposure makes a baby’s developing brain more susceptible to addiction. It also hinders fetal lung development, and increases the risk of sudden infant death syndrome.

In March 2019, CDC released a report studying the use of EVPs in Oklahoma and Texas in 2015. In those states, about one in 15 women who had a recently given birth used EVPs around the time of pregnancy. “Among women who smoked cigarettes in the past 2 years and had ever used EVPs, dual use of EVPs and cigarettes was higher in the 3 months before pregnancy,” the report found. It seemed that almost half the women who started EVPs before or during pregnancy viewed EVPs as a “bridge” or a cessation device to quit tobacco. However, these products are not U.S. Food and Drug Administration-approved as cessation devices, and there is no evidence to suggest that EVPs are a better alternative to tobacco use, especially given what appears to be a link between EVP and lung illness.

Physicians and other health experts suggest other approaches.

Current recommendations for pregnant (or soon-to-be pregnant) women seeking to quit smoking include behavioral intervention as a first-line treatment and nicotine replacement therapy with close supervision of a clinician as a second-line option.

As a medical student in my 20s, I have seen many women around me of childbearing age using EVPs, often as an “accessory” to a night out. I suppose they believe EVPs are safer than cigarettes. Paradoxically, young people who use EVPs are more likely to start smoking conventional tobacco products, instead of using EVPs as an alternative to conventional tobacco. Forty-four percent of EVP users are millennials (people born between 1977 and 1994), and these are the women who are most likely to become pregnant. Research shows that even younger kids have become interested in the EVP market as well. 

This worries me as a millennial and as a medical student. With the rise in use of EVPs and the growing evidence of vape-related serious health problems and even deaths, and the fact that some vapers ultimately turn to tobacco, the health threats EVPs pose seem to far outweigh any potential benefits. Add to that the risk to women wanting to have a baby, and the choice seems clear: Stay away from EVPs.

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