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Impact of In Utero Electronic Nicotine Delivery System Exposure on Neonatal Birth OutcomesVaping during pregnancy may increase risks of preterm birth

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Key Takeaway
In utero exposure to electronic nicotine delivery systems is associated with higher odds of preterm birth and lower birthweight.

This meta-analysis evaluated the impact of in utero exposure to electronic nicotine delivery systems (ENDS) on neonatal outcomes. The analysis compared infants exposed to ENDS against those exposed to combustible cigarettes, nicotine replacement therapies, or no nicotine exposure at all.

Findings indicate that neonates exposed to ENDS faced significantly higher odds of preterm birth compared to those who were not exposed. Additionally, these infants demonstrated lower birthweights. While the data for small for gestational age (SGA) and gestational age did not show statistically significant differences between groups, the risk of preterm birth remains a primary concern.

When comparing ENDS to combustible cigarettes, no significant differences were found regarding preterm birth or gestational age. However, infants exposed to combustible cigarettes also showed lower birthweights. These results suggest that ENDS may pose risks to neonatal development similar to traditional tobacco products.

Clinical confidence in these findings ranges from low to moderate due to potential biases and limited classification of exclusive ENDS use. These results underscore the importance of addressing vaping among pregnant individuals to mitigate risks of adverse birth outcomes.

How this fits prior evidence

This meta-analysis addresses a gap in understanding the specific impact of electronic nicotine delivery systems (ENDS) on neonatal outcomes. While prior coverage noted that electronic cigarettes can increase quit rates compared to nicotine replacement therapy, this finding provides evidence that in utero exposure to these devices is associated with increased odds of preterm birth, a risk comparable to combustible cigarettes.

When a parent uses electronic nicotine delivery systems (vaping) during pregnancy, the impact on the developing baby is a major concern. A review of 22 studies looked at how these products affect newborns compared to those exposed to traditional cigarettes or no nicotine at all. The findings show that babies exposed to vaping products had significantly higher odds of being born prematurely compared to those not exposed to any nicotine.

The research also found that babies exposed to vaping had lower birth weights than those who were not exposed. While the study did not find a significant difference in birth weight between those exposed to cigarettes and those exposed to vapes, the data suggests that vaping carries risks similar to traditional smoking. These risks are particularly concerning for the health of the infant during the critical early stages of life.

It is important to note that the evidence for some of these findings is not yet perfectly clear. Because some studies had limited ways to track exclusive vaping use, the confidence in some results is low to moderate. However, the findings highlight a clear need for better support and intervention for parents looking to quit vaping during pregnancy.

What this means for you:
Vaping during pregnancy is linked to higher rates of preterm birth and lower birth weights in newborns.

Common questions

Is vaping during pregnancy risky for the baby?

Yes, the data shows that babies exposed to vaping products in the womb have significantly higher odds of being born prematurely compared to babies not exposed to nicotine. These babies also showed lower birth weights. Because of these risks, the findings suggest that vaping may pose a risk to the baby similar to traditional cigarette smoking.

How does vaping compare to traditional cigarettes for newborns?

The study found no significant difference in preterm birth rates between babies exposed to cigarettes and those exposed to vapes. However, babies exposed to cigarettes also showed lower birth weights than those exposed to vapes. Because the evidence is limited by some factors, these results are considered to have low to moderate confidence.

Are the results of this study certain?

The findings have varying levels of certainty. The link between vaping and preterm birth has moderate confidence, while the data regarding birth weight and other factors has lower confidence. These limitations exist because some studies had difficulty specifically identifying cases of exclusive vaping use.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
INTRODUCTION: Despite electronic nicotine delivery systems (ENDS) being used for smoking cessation during pregnancy, the relative consequences are still unclear. Here, we systematically reviewed and meta-analyzed birth outcomes associated with ENDS use. METHODS: This review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. OVID (MEDLINE, EMBASE, PsycINFO) and PubMed databases were searched from inception until August 2025, for studies comparing outcomes from in utero exclusive ENDS exposure to non-exposed, exclusive nicotine replacement therapy-exposed, or exclusive combustible cigarette (CC)-exposed neonates. RESULTS: We included k = 22 studies with k = 10 independent samples. In ENDS-exposed vs non-exposed births, there were significantly greater odds of preterm birth (k = 3; moderate confidence) but not small for gestational age (SGA; k = 3; low confidence); these findings were less robust to sensitivity analysis. Additionally, there was no significant difference in SGA (k = 3; moderate confidence) or preterm birth (k = 3; high confidence) between CC-exposed and ENDS-exposed neonates; these findings were robust to sensitivity analysis. Analysis of continuous outcomes found lower birthweight in ENDS- vs non-exposed neonates (k = 4; moderate confidence) and lower birthweight in CC- vs ENDS-exposed neonates (k = 4; low confidence), and no difference in gestational age in either comparison (low confidence). Narrative synthesis suggests quitting ENDS was associated with better birth outcomes, and associations between ENDS and delayed development of infant motor maturity and reflexes. CONCLUSION: ENDS exposure may confer comparable risk as cigarette smoking to preterm birth. Further research is needed given low to moderate confidence in findings and risk of bias conferred by limited classification of exclusive ENDS use. IMPLICATIONS: With respect to adverse birth outcomes, ENDS may constitute a risk compared to no-nicotine exposure, suggesting the importance of investigating vaping cessation interventions, as well as greater research into alternative smoking cessation interventions for people who are pregnant or want to become pregnant.
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