Midwives are pushing for gaping holes in knowledge around e-cigarettes and maternal health to be filled, saying they are struggling to answer questions from their pregnant patients.
Most pregnant women are screened for smoking status and encouraged to quit during pregnancy.
But at a time when the number of young women vaping is on the rise, a major lack of information related to pregnancy in e-cigarette studies means the impact of vaping on maternal health is little understood.
Amelia Yazidjoglou, a PhD candidate at the Australian National University's National Centre for Epidemiology and Population Health, has conducted a review of 20 different e-cigarette health outcomes across 400 separate studies.
The review found only three studies with information about vaping and pregnancy.
"Unfortunately, we have very little or almost no data around any pregnancy, reproductive or developmental outcome for e-cigarettes," she said.
"An absence of evidence doesn't mean there's an absence of risk — it just means we can't tell you at this point in time."
Two of the studies that did have information about vaping and pregnancy found e-cigarettes were associated with smaller babies, while one showed there were lower rates of breastfeeding at the time of discharge from hospital.
"It's important to remember this are only three studies," Ms Yazidjoglou said.
"This is what they reported — but overall we are really quite uncertain about what the effects are, and there's … insufficient evidence for us to make any strong conclusion about their effects."
Unanswered questions
Ms Yazidjoglou addressed the Victorian Maternal Child Health conference in March and said midwives had concerns, and many unanswered questions around educating pregnant women and new mothers about vaping.
They ranged from questions about referring pregnant women to e-cigarettes to curb tobacco smoking, to the impacts on breastfeeding and the risks of second-hand vapour on infants and children.
These huge knowledge gaps were being felt in the sector, Ms Yazidjoglou said.
"We have got really little data to help these [health professionals] provide the best care for their patients," she said.
More midwives at the study table
Amid the small amount of data on vaping and pregnancy, midwives and maternal health professionals are encouraging patients to quit all types of smoking.
Australian College of Midwives midwifery adviser Tani Paxton said that messaging was particularly important as more young women started vaping.
"Because we don't know the effects, it's really hard to predict what that's going to look like, and we can only reflect on the damage that smoking does," she said.
Collecting the necessary data to draw solid conclusions is challenging.
Ms Paxton said randomised control trails were unethical, while researchers said studying and recruiting pregnant women who vaped was also difficult.
Ms Paxton said it was important to include more midwives in future e-cigarettes studies.
"We have got these incredible midwifery researchers across the country and we just need a voice at the table," she said.
"Wherever this research is being done, it's my hope that we have a midwife present as well so that advice coming across, and that information being collated, is appropriate and correct."
What researchers do know is that nicotine, which is found in many e-cigarettes, is addictive. It can lead babies who are exposed in utero to experience withdrawal, causing irritability, discomfort, lots of crying and challenges settling.
"And that's a really hard way to start your life," Ms Paxton said.
More young women vaping
According to Quit Victoria, e-cigarette usage has increased five-fold among young women aged 18-24, from 2.8 per cent in 2018-19 to 15.2 per cent in 2022, and about 54 per cent of adult Victorian e-cigarette users are aged under 30 years.
Quit Victoria director Matthew Scanlon said quitting vaping was "extremely difficult".
"Often, the amount of nicotine people are ingesting is completely unknown to them, because many e-cigarette products are not labelled correctly or not labelled at all," he said.
"Often people don't even know the vape they are using contains nicotine."
NSW Health said it was committed to providing vaping cessation support to women before, during and after pregnancy.
