Can I vape while pregnant?

The verdict

Two respected bodies give opposite-sounding advice, and printing an average of them would be useless. Here is each position in its own words.

The NHS. Current evidence on e-cigarettes indicates they are much less risky than smoking. E-cigarettes do not produce tar or carbon monoxide, the two main toxins in cigarette smoke, and carbon monoxide is particularly harmful to developing babies. The vapour does contain some of the potentially harmful chemicals found in cigarette smoke, but at much lower levels. If using an e-cigarette helps you to stop smoking, it is much safer for you and your baby than continuing to smoke.

ACOG. E-cigarettes contain nicotine, plus flavouring and a propellant that may not be safe for you or your fetus. Avoid e-cigarettes, or vaping, during pregnancy.

Notice what the NHS statement is and is not. It is a comparison with smoking. It is not a statement that vaping is safe. Nobody claims that.

Which advice applies to you

The disagreement mostly dissolves once you identify your starting point, because the two bodies are answering different questions.

If you smoke and vaping is how you stop. The NHS position is designed for exactly this, and it is unambiguous. Carbon monoxide restricts the oxygen supply to your baby, and the NHS states that when you stop smoking, harmful gases such as carbon monoxide and other damaging chemicals clear from your body. It lists the benefits: reduced risk of complications in pregnancy and birth, reduced risk of stillbirth, a baby less likely to be born too early or with low birth weight, and reduced risk of sudden infant death syndrome.

If you do not smoke and are thinking of vaping. There is no argument for starting. The comparative benefit only exists relative to cigarettes; against not vaping at all, there is no upside and an unquantified downside. Both bodies would tell you not to.

If you already vape and do not smoke. This is the situation most people are actually in when they search this, and it is the one neither body addresses squarely. The NHS route is to treat vaping as a stop-smoking tool with an eventual exit, and it points to advice on quitting vaping too. ACOG would tell you to stop. Neither says a pregnancy is at established risk from vaping alone, because that evidence does not exist.

What is actually known, and what is not

The Office for Health Improvement and Disparities commissioned a series of independent evidence reviews on vaping in England, the last published in September 2022 by leading independent tobacco experts. Those reviews are the basis of the NHS position and they are consistent on the central comparison: vaping poses a small fraction of the risks of smoking in the short and medium term.

They are equally clear about what is missing. Long-term data does not exist, because the products are too new. Pregnancy-specific data is thin. Product composition changes rapidly, so studies of devices from five years ago describe something different from what is sold now.

The NHS itself says e-cigarettes are fairly new and there are still some things we do not know. That is a fair statement of the position, and it is why ACOG's caution is not unreasonable even though its conclusion differs.

Nicotine on its own

Nicotine is a vasoconstrictor and it does cross the placenta. The NHS's framing is that by itself, nicotine is relatively harmless, meaning relative to the thousands of other compounds in tobacco smoke. That is not the same as saying it is inert.

The UK's practical answer to this is nicotine replacement therapy, which the NHS says you can use during pregnancy if it helps you stop smoking and you cannot stop without it. NRT contains only nicotine and none of the damaging chemicals in cigarettes, and it can be prescribed by a GP or NHS stop smoking adviser or bought from a pharmacy. Two specifics attach to it: patches should be used for no more than 16 hours in any 24, removed at bedtime, and patches may suit better if you have pregnancy nausea and vomiting.

The NHS also says stop smoking tablets such as varenicline and bupropion are not recommended in pregnancy. That is a medicines question rather than a vaping one, and it belongs with your midwife or GP.

Flavours, and the one flavour the NHS names

There is a specific and easily missed instruction in the NHS pregnancy guidance: pregnant women are advised to avoid liquorice-flavoured nicotine products.

The NHS explains the reasoning honestly. There is no known risk with small amounts of liquorice flavouring, and the caution comes from the manufacturers rather than from evidence, based on the adverse effects associated with excessive amounts of liquorice root. Its suggestion is simply to choose another flavour, such as fruit or mint.

That is the only flavour-specific pregnancy instruction the NHS gives. It does not restrict any other flavour, and no other authority publishes a flavour list for pregnancy.

Practical points that matter

• E-cigarettes are not available on NHS prescription. NRT is. If cost is the deciding factor, that is worth knowing.
• You can still get free stop smoking support if you vape. The NHS says so explicitly, and a midwife can refer you. The National Smokefree helpline is 0300 123 1044.
• Dual use is the worst outcome. Vaping alongside continued smoking keeps the carbon monoxide exposure that the whole argument is about eliminating.
• Second-hand exposure. The NHS is firm that second-hand smoke reduces birth weight and raises SIDS risk, and that a partner who smokes affects you and your baby. It makes no equivalent claim about second-hand vapour.
• Buy regulated products. UK e-liquids are capped at 20mg/ml nicotine and are subject to notification requirements. Illicit products are not, and that is where contamination problems arise.

If you have been vaping through this pregnancy

Nothing here suggests you have caused harm, and no authority claims established fetal damage from vaping alone. What both bodies would agree on is the direction of travel: less is better, and stopping is better still.

Tell your midwife. Carbon monoxide monitoring is offered routinely at UK antenatal appointments, and it is a useful conversation rather than a test to dread, because vaping does not raise carbon monoxide the way smoking does.

If you switched from smoking to vaping during this pregnancy, that is a genuine improvement by the NHS's own account, and it is worth saying so out loud rather than treating it as a confession.

Where guidance differs

The UK treats vaping as a quitting tool. The NHS says e-cigarettes are much less risky than smoking, that switching is much safer for you and your baby than continuing, and that free stop smoking support remains available to people who vape.

The US advises against it. ACOG's patient guidance says to avoid e-cigarettes during pregnancy, on the basis that they contain nicotine plus flavouring and a propellant that may not be safe for you or your fetus.

Both agree smoking is worse. Neither body suggests continuing to smoke in preference to vaping, and neither claims vaping is safe in absolute terms.

Only the UK names a flavour. Liquorice-flavoured nicotine products are singled out for avoidance in NHS pregnancy guidance, on manufacturer caution rather than evidence.