Impact of electronic nicotine delivery systems (ENDS) on fetal outcomes: A systematic review and meta-analysis

INTRODUCTION The introduction of electronic nicotine delivery systems (ENDS) has altered smoking status, particularly among adults of reproductive age. Despite perceptions of ENDS as safer alternatives to conventional cigarettes (CCs), their impact on perinatal outcomes remains poorly understood. This systematic review and meta-analysis aim to elucidate the effects of ENDS use during pregnancy on fetal health and pregnancy outcomes. METHODS We conducted a comprehensive literature search using Scopus, Medline (PubMed) and Web of Science, focusing on studies that examine the effects of ENDS on pregnancy and neonatal outcomes. We limited the search to publications in English. We selected articles based on their relevance to pregnancy outcomes associated with ENDS use. Due to the low heterogeneity among the included studies, we calculated odds ratios (ORs) using fixed effects RESULTS The search identified six relevant studies. Our meta-analysis included 4 studies for the outcome small-for-gestational age (SGA), 3 for the outcome preterm birth (PB) and 2 for the outcome low birth weight (LBW). The meta-analysis provided further statistical evidence, indicating that women who used e-cigarettes during pregnancy had significantly higher risks of SGA I2=0%), and LBW (OR=1.55; 95% CI: 1.15-2.09, I2=0%) compared to nonCONCLUSIONS ENDS use during pregnancy is associated with significant adverse perinatal outcomes. These findings support public health policies promoting complete abstinence from both CC and ENDS among pregnant women to ensure the best perinatal outcomes.