cesarean birth (RR = 1.182).<\/li>\n<\/ul>\nSeveral serious complications, including myocardial infarction (RR = 2.422), death (RR = 2.522), deep vein thrombosis (RR = 1.445), infection (RR = 1.445), wound complications (RR = 1.941) and pulmonary embolism (RR = 1.691), were also more common among patients with NTND.<\/p>\n
West and colleagues additionally found NTND was associated with greater ED visits (RR = 1.416), opioid abuse (RR = 15.743) and readmissions (RR = 1.466).<\/p>\n
NTND was not tied to sepsis; hemolysis, elevated liver enzymes and low platelets syndrome; hemorrhage; or congenital cardiac anomalies.<\/p>\n
West said the findings underline \u201can important clinical message: \u2018safer\u2019 does not mean safe, especially during pregnancy. Just because a product does not contain combustible tobacco does not mean it is harmless. Nicotine itself has significant physiologic effects that can impact both maternal and fetal health.\u201d<\/p>\n
She noted that a \u201cstriking\u201d finding was the strong link between NTND and opioid abuse. \u201cThis does not imply causation, but it highlights that nicotine exposure may serve as an important marker for broader high-risk health behaviors and social factors that require closer attention during prenatal care,\u201d she said.<\/p>\n
Health care professionals \u201cshould broaden how they screen for nicotine use in pregnancy,\u201d West explained. \u201cMany patients do not consider vaping, nicotine pouches, or other non-tobacco nicotine products to be \u2018tobacco use,\u2019 so these exposures may go unrecognized unless we ask specifically.\u201d<\/p>\n
Clinician counseling on non-tobacco nicotine use \u201cshould reflect that nicotine itself \u2014 not just cigarettes \u2014 can contribute to adverse pregnancy outcomes. As nicotine use evolves, our screening and patient education need to evolve as well,\u201d West said.<\/p>\n
Nicholas Stansbury, MD, <\/b>FACOG,<\/b> a study co-author and specialist fellow at the University of Texas Health San Antonio, told Healio that additional prospective research on the effects of non-tobacco products is necessary, \u201cparticularly as these products become more common. Larger studies and future systematic reviews will help clarify the true magnitude of risk and whether certain products may be more harmful than others. We also need better patient education and cessation strategies specifically designed for vaping and alternative nicotine products, since many current counseling approaches are still focused primarily on traditional cigarette smoking.\u201d<\/p>\n
Ultimately, the greatest takeaway from the data \u201cis that the conversation around nicotine use in pregnancy has changed,\u201d Stansbury said. \u201cWe can no longer focus only on cigarettes. Patients are increasingly using newer nicotine products with the belief that they are safer or harmless. Our responsibility as physicians is to make sure our counseling reflects the current evidence and addresses all forms of nicotine exposure.\u201d<\/p>\n
For more information:<\/h2>\n
Madeline West<\/b> <\/b>and Nicholas Stansbury, MD, FACOG<\/b>, <\/b>can be reached at primarycare@healio.com.<\/p>\n\n
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Sources\/Disclosures<\/h3>\n Source: <\/h2>\n
West M, et al. Non-tobacco nicotine products and their association with adverse pregnancy outcomes: A multi-institutional 1:1 propensity matched cohort analysis. Presented at: ACOG Annual Clinical & Scientific Meeting; May 1-3, 2026; Washington.<\/p>\n
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\n Disclosures: <\/strong>
\n West and colleagues report no relevant financial disclosures.
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