Action on Smoking And Health. Use of e-cigarettes among young people in Great Britain. Action on Smoking and Health. Action on Smoking and Health. 2019. (accessed 23 March 2020)

Bareham D, Ahmadi K, Elie M, Jones AW. E-cigarettes: controversies within the controversy. The Lancet Respiratory Medicine. 2016; 4:(11)868-869

Beard E, Jackson SE, West R, Kuipers MAG, Brown J. Population-level predictors of changes in success rates of smoking quit attempts in England: a time series analysis. Addiction. 2020; 115:(2)315-325

Blount BC, Karwowski MP, Shields PG Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI. New England Journal of Medicine. 2020; 382:(8)697-705

Iterative Approach - an overview. Management of a Software Application's Versions, Iterative approach. Certifiable Software Applications 2. 2017. (accessed 27 May 2020)

Bowker K, Orton S, Cooper S Views on and experiences of electronic cigarettes: a qualitative study of women who are pregnant or have recently given birth. BMC Pregnancy Childbirth. 2018; 18:(1)

British Broadcasting Company. Vaping: How popular are e-cigarettes?. 2018. (accessed 13 March 2020)

Chand HS, Muthumalage T, Maziak W, Rahman I. Pulmonary Toxicity and the Pathophysiology of Electronic Cigarette, or Vaping Product, Use Associated Lung Injury. Front Pharmacol. 2020; 10

Cooper S, Orton S, Campbell KA Attitudes to E-Cigarettes and Cessation Support for Pregnant Women from English Stop Smoking Services: A Mixed Methods Study. International Journal of Environmental Research and Public Health. 2019; 16:(1)

Cooper S, Orton S, Leonardi-Bee J, Brotherton E. Smoking and quit attempts during pregnancy and postpartum: a longitudinal UK cohort. BMJ Open. 2017; 7

E-Cigarettes: Prevalence and Attitudes in Great Britain. 2013. (accessed 2 March 2020)

E-Cigarettes: The Extent and Impact of Complementary Dual-Use. 2015. (accessed 14 December 2020)

Hajek P, Phillips-Waller A, Przulj D A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. N Engl J Med. 2019; 380:(7)629-637

Jackson SE, Shahab L, West R, Brown J. Associations between dual use of e-cigarettes and smoking cessation: A prospective study of smokers in England. Addictive Behaviors. 2020; 103

Jankowski M, Lawson J, Shpakou A, Poznanski M, Klimatckaia L. Smoking Cessation and Vaping Cessation Attempts among Cigarette Smokers and E-Cigarette Users in Central and Eastern Europe. Int J Environ Res Public Health. 2019; 17:(1)

Kasza KA, Ambrose BK, Conway KP Tobacco-Product Use by Adults and Youths in the United States in 2013 and 2014. New England Journal of Medicine. 2017; 376:(4)342-353

Li G, Chan YL, Nguyen LT Impact of maternal e-cigarette vapor exposure on renal health in the offspring. Annals of the New York Academy of Sciences. 2019; 1452:(1)65-77

Liu X, Lugo A, Davoli E, Gorini G, Pacifici R, Fernández E, Gallus S. Electronic cigarettes in Italy: a tool for harm reduction or a gateway to smoking tobacco?. Tobacco Control. 2020; 29:(2)148-152

Mann R, Faflik F. Survey of smoking cessation services and pregnant women's views on use of electronic cigarettes in pregnancy. Journal of Health Visiting. 2018; 6:(1)32-39

National Centre for Smoking Cessation and Training. Stopping Smoking in Pregnancy: A briefing for maternity care providers. 2019. (accessed 8 October 2019)

NHS. Stopping smoking in pregnancy: Your pregnancy and baby guide. 2019a. (accessed 28 August 2019)

National Institute for Health and Care Excellence. Smoking cessation interventions and services: evidence reviews for advice on e-cigarettes on general sale. 2018. (accessed 8 January 2020)

Nursing and Midwifery Council. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. 2020. (accessed 8 June 2020)

Orzabal M, Ramadoss J. Impact of electronic cigarette aerosols on pregnancy and early development. Current Opinion in Toxicology. 2019; 14:14-20

Public Health England. E-cigarettes: regulations for consumer products Guidance on how to get an e-cigarette on the market in the UK, including the notification scheme and reporting problems with e-cigarettes. 2016. (accessed 27 May 2020)

Public Health England. Vaping in England: an evidence update February 2019 A report commissioned by Public Health England. 2019. (accessed 27 May 2020)

Royal College of Midwives. Position statement: Support to quit smoking in pregnancy. 2019. (accessed 28 August 2019)

Royal College of Physicians. Smoking and Health: Summary of a Report of the Royal College of Physicians on Smoking in Relation to Cancer of the Lung and Other Diseases. 1962. (accessed 3 January 2020)

Royal College of Physicians. Nicotine without smoke: Tobacco harm reduction. 2016. (accessed 13 May 2020)

Royal College of Physicians. Hiding in plain sight: Treating tobacco dependency in the NHS. 2018. (accessed 13 May 2020)

Schilling L, Schneider S, Karlheim C, Maul H, Tallarek M, Spallek J. Perceived threats, benefits and barriers of e-cigarette use during pregnancy. A qualitative analysis of risk perception within existing threads in online discussion forums. Midwifery. 2019; 79

Stanbrook MB, Drazen JM. Vaping-Induced Lung Disease — A Look Forward by Looking Back. New England Journal of Medicine. 2020; 382:(17)1649-1650

Stroud LR, Papandonatos GD, Borba K, Kehoe T, Scott-Sheldon LAJ. Flavored electronic cigarette use, preferences, and perceptions in pregnant mothers: A correspondence analysis approach. Addictive Behaviors. 2019; 91:21-29

Walker N, Parag V, Verbiest M, Laking G, Laugesen M, Bullen C. Nicotine patches used in combination with e-cigarettes (with and without nicotine) for smoking cessation: a pragmatic, randomised trial. The Lancet Respiratory Medicine. 2020; 8:(1)54-64

Walley SC, Wilson KM, Winickoff JP, Groner J. A Public Health Crisis: Electronic Cigarettes, Vape, and JUUL. Pediatrics. 2019; 143:(6)

E-cigarette Use and Smoking Cessation in Adult Cigarettes Smokers: A Systematic Review and Meta-Analysis. 2020. (accessed 14 December 2020)

World Health Organization. Introduction to Basic Epidemiology and principles of statistics for tropical disease control (archived). 2001. (accessed 14 December 2020)

Midwives' recommendation of electronic cigarettes as a smoking cessation strategy in pregnancy

02 January 2021
18 min read
Volume 29 · Issue 1



Electronic cigarettes have been described as a public health crisis. Approximately 10.6% of pregnant women smoke conventional cigarettes at the time of delivery, but the prevalence of e-cigarette use during pregnancy is unknown.


To assess the extent of midwives' current knowledge and attitudes on electronic cigarettes as a smoking cessation strategy during pregnancy.


Electronic databases were searched. These were supplemented by manual searches, which were completed to include reports from Public Health England and the Royal College of Midwives.


A total of 22 papers were identified, reviewed and are presented as a narrative literature review. Topics such as epidemiology, organisational stances, opinions of smoking cessation in pregnancy and opinions from stop smoking services were explored. There have been conflicting ideas regarding the use of electronic cigarettes in pregnancy and women who have recently given birth.


Whilst the current literature regarding electronic cigarettes as a smoking cessation strategy during pregnancy is well explored, there is no literature that investigates the attitudes of midwives and how this may affect their recommendation of e-cigarettes. The results of this study could serve as a point of reference for future clinical research, as well as clinical practice, by bringing to light the knowledge and attitudes midwives have regarding electronic cigarette use in pregnancy, and may be able to suggest some changes to improve the current practices.

Electronic cigarettes (e-cigarettes) were first introduced in China in 2004 (Dockrell et al, 2013); however, their use has only become widespread in recent years (Bareham et al, 2016). An e-cigarette is a device that delivers nicotine to the lungs in the form of a vapour and can also be referred to as vaping. The prevalence of electronic cigarettes is ever-increasing, with around 3.6 million electronic cigarette users, a rise from the 700 000 vapers in 2012 (Action on Smoking And Health, 2019). Euromonitor, a market research group, have predicted that the rapidly expanding e-cigarette market will have around 55 million users by 2021 (British Broadcasting Company, 2018). According to data published by the NHS, the prevalence of e-cigarette use among pregnant women is unknown; however, approximately 10.6% of pregnant woman smoke conventional cigarettes at the time of delivery (NHS, 2018).

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