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To the Editor:

We read with interest Nian et al.’s recent analysis1 of data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to examine whether e-cigarette (EC) use during pregnancy may support smoking cessation. We found the results encouraging in that among women who were smoking before pregnancy, but initiated EC use during their pregnancy (“EC initiators”), approximately 30% completely discontinued smoking during pregnancy as well as postpartum. Accordingly, we were dismayed that the authors concluded that “ECs should not be considered a viable gestational smoking cessation strategy,” and believe that this conclusion is not only unsupported but is in opposition to the results presented.

Nian et al. report that 29.7% of EC initiators stopped smoking combustible cigarettes (CCs) completely during their pregnancy, and this proportion persisted (though not necessarily the same individuals) in the 2-6 months after delivery (30.1% of EC initiators vs. 8.5% of those who exclusively smoked cigarettes throughout pregnancy). Moreover, EC initiators were less likely to maintain or increase their cigarette consumption than those who exclusively smoked (< 20% vs. ~40%, respectively). While the observational data preclude causal inferences, the findings are consistent with Cochrane systematic reviews and meta-analyses2 showing that e-cigarettes are effective for smoking cessation, as well as real-world evidence that e-cigarettes can help adults who smoke (AWS) switch completely away from smoking.3

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