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In their letter to the editor, Selya and Kim (S&K) argue that electronic cigarettes (ECs) should be considered a viable prenatal smoking cessation tool that could help limit the harmful effects of combustible cigarettes (CCs).1 We appreciate the authors’ perspective and this opportunity to clarify our position. We acknowledge that EC initiation may well help pregnant mothers decrease or eliminate prenatal CC use and reduce harm to mothers and offspring relative to sustained CC use. However, we do not believe that the current evidence of efficacy and safety is compelling enough to recommend EC initiation for smoking cessation.

As the authors noted, in prespecified secondary analyses from the only randomized controlled trial (RCT) known to us, pregnant mothers assigned to an EC arm were more likely to achieve CC cessation than those assigned to a nicotine replacement patch arm. (This analysis eliminated those in the EC arm that also used nicotine patches and those in the nicotine patch arm that also used ECs.) Low birth weight was also less common in the EC arm.2 If the only cessation strategies available to pregnant mothers were nicotine replacement and ECs, the evidence from this single trial would favor ECs. However, these are not the only pathways to cessation. Quitting is common among pregnant smokers who do not use ECs3 (54% in our study4), and there is robust evidence supporting behavioral smoking cessation interventions, though there are notable barriers to access and uptake.5

Issue Section:
Letters
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