BACKGROUND AND PURPOSE:

• Prenatal cigarette exposure has been shown to lead to neurodevelopmental deficits
• Froggatt et al. (EClinicalMedicine, 2021) compared neurobehavioural outcomes in newborns exposed to cigarettes vs e-cigarettes

METHODS:

• Case-control study
• Participants
  • Infants approximately 1 month old
• Exposures
  • Prenatal cigarettes
  • Prenatal e-cigarettes
  • Neither
• Analysis
  • Potential covariates (maternal age, infant sex, primiparity, additional household smokers, stress, depression and anxiety) were assessed
• Primary outcomes
  • Birth outcomes
    • Gestation | Birthweight | Head circumference
  • Scores on the Neonatal Behavioural Assessment Scale (NBAS)
    • Reflexes | Regulation | Motor maturity, orientation, range of states and automatic stability

RESULTS:

• E-cigarette exposure: 10 infants | cigarette exposure: 29 | no exposure: 44
• Both cigarette and e-cigarette exposed infants had a significantly greater number of abnormal reflexes
  • Cigarettes: P = 0.001
  • E-cigarettes: P = 0.002
• Compared to non-exposure, cigarette exposed infants performed significantly worse for
  • Self-regulation: P = 0.010
  • Motor maturity: P = 0.002
• Compared to non-exposure, e-cigarette exposed infants also had decreased motor maturity, but only marginally worse self-regulation (not-significant)
  • Self-regulation: P = 0.057
  • Motor maturity: P = 0.036
• Compared with non-exposure, cigarette exposed infants had significantly
  • Lower birthweight: P = 0.021
  • Reduced head circumference: P = 0.008
• However, compared with non-exposure, e-cigarette exposed infants had no difference in
  • Birthweight
  • Gestation
  • Head circumference

CONCLUSION:

• Infants exposed to e-cigarettes prenatally do not appear to have worse birth outcomes than non-exposed infants
• However, exposed children do have abnormal primitive reflexes and marginally decreased self-regulation abilities
• The authors conclude

This is the first study assessing neurobehavioural outcomes associated with prenatal nicotine exposure through cigarettes or e-cigarettes at one month old

…the present findings indicate that there could be harm associated with e-cigarette use and therefore the ultimate aim must be to stop smoking, without the use of e-cigarettes. Indeed, caution should probably be applied to all NRT products

Given the predictive nature of newborn assessments, in particular the NBAS, the notion that nicotine by itself is relatively harmless, is a concept that needs to be further questioned and further investigated

Learn More – Primary Sources:

The effects of prenatal cigarette and e-cigarette exposure on infant neurobehaviour: A comparison to a control group

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