Electronic Cigarettes During Pregnancy: Impact on Fetal Development

项目摘要/摘要 虽然美国的香烟使用量有所下降，但电子烟(e-cig)的使用量却大幅增加 自2007年引入美国以来。关于它们的潜在风险，出现了巨大的争议 (重新正常化吸烟，电子液体的危险)与潜在的减少危害(“清洁”尼古丁输送系统-- 不含烟草燃烧产物的电子显微镜)。风险与减少危害的问题更加突出。 在怀孕期间，由于母亲使用的药物对母亲和胎儿的影响，以及存在易受伤害的证据- 发育中的胎儿对尼古丁和燃烧产物的反应。最近发布的报告显示 孕妇使用电子烟的比率为4%-15%；我们小组的试点数据显示，产前电子烟的使用率翻了一番。 2012至2017年间的CIG使用情况。鉴于有证据表明孕妇越来越多地使用电子烟，已知的胎儿毒素- ICity远离尼古丁，需要数据来通知孕妇和产科提供者，研究以阻止- 迫切需要挖掘电子烟对胎儿发育的影响和相对影响。 然而，到目前为止，还没有发表过关于怀孕期间使用电子烟对胎儿发育影响的研究。 门槛。我们提出了首次研究怀孕期间电子烟对发育中的胎儿的影响，在... 包括胎儿生长的标记物和胎儿大脑和神经行为发育的新指标。 我们小组率先联合使用实时超声和胎儿心动图来确定胎儿的特征 神经行为。三维超声的出现提供了更高分辨率的胎儿图像，并允许体积测量- 特定胎儿大脑结构的特征化。来自我们小组的开创性初步数据强调了 招募怀孕电子烟使用者以及胎儿生长发育、胎儿额小脑改变的初步证据 电子烟使用者的脑结构和胎儿神经行为发育。拟议的研究是一项密集的支持- 对E-CIG使用者、CIG使用者和对照组三组母婴配对进行了仔细的调查。明白了- 胎儿生长、神经结构和神经行为发育的测量将通过孕期评估。 Nancy使用二维和三维超声检查，随后进行新生儿超声和神经行为评估。 母体和胎儿尼古丁、燃烧和致癌生物标记物也将得到评估。我们的目标是 确定产前电子烟对以下方面的影响：(1)胎儿生长和婴儿出生体重，(2)胎儿/婴儿大脑发育- (3)胎儿/婴儿神经行为发育。我们还将探索：(4)尼古丁与 以及毒性生物标志物与胎儿生长、大脑和神经行为发育的关系。建议的研究广告- 着装了一个紧急而又悬而未决的公共卫生问题。鉴于电子烟使用率的不断提高，以及精湛的- 发育中的胎儿对产前环境中的干扰的敏感性，决定了风险和相关性 怀孕期间使用电子烟的风险是及时的，并有可能影响生育年龄的健康 妇女和她们的孩子。

Project Summary/Abstract While cigarette use has declined in the US, use of electronic cigarettes (e-cigs) has increased dramatically since their introduction to the US in 2007. Tremendous controversy has emerged regarding their potential risks (renormalizing smoking, dangers of e-liquids) versus potential for harm reduction (“clean” nicotine delivery sys- tem without tobacco combustion products). The question of risks vs harm reduction is even more salient during pregnancy due to impact of maternal use on both mother and fetus and evidence for vulnerabil- ity of the developing fetus to both nicotine and combustion products. Recent published reports reveal rates of e-cig use of 4-15% among pregnant women; pilot data from our group revealed doubling of prenatal e- cig use between 2012 and 2017. Given evidence of increasing e-cig use by pregnant women, known fetal tox- icity from nicotine, and a need for data to inform pregnant women and obstetric providers, research to deter- mine the impact and relative impact (vs cigarettes) of e-cigs on fetal development is urgently needed. To date, however, there are no published studies of the impact of e-cig use during pregnancy on fetal develop- ment. We propose the first study of the impact of e-cigs during pregnancy on the developing fetus, in- cluding markers of fetal growth and novel measures of fetal brain and neurobehavioral development. Our group pioneered combined use of real-time ultrasound and fetal actocardiography to characterize fetal neurobehavior. The advent of 3D ultrasound offers higher resolution fetal images and allows volumetric char- acterization of specific fetal brain structures. Seminal preliminary data from our group highlights feasibility of recruiting pregnant e-cig users as well as initial evidence for alterations in fetal growth, fetal fronto-cerebellar brain structures and fetal neurobehavioral development in e-cig users. The proposed study is an intensive pro- spective investigation of three groups of mother-fetus pairs: E-cig users, Cig users and Controls. Comprehen- sive measures of fetal growth, neural structures, and neurobehavioral development will be assessed over preg- nancy using 2D and 3D ultrasonography followed by neonatal ultrasound and neurobehavioral assessment. Maternal and fetal nicotine, combustion and carcinogenicity biomarkers will also be assessed. Our goals are to determine the impact of prenatal e-cigs on: (1) fetal growth and infant birth weight, (2) fetal/infant brain devel- opment, (3) fetal/infant neurobehavioral development. We will also explore: (4) associations between nicotine and toxicity biomarkers with fetal growth, brain and neurobehavioral development. The proposed study ad- dresses an urgent and unanswered public health question. Given increasing rates of e-cig use and the exquis- ite sensitivity of the developing fetus to disruptions in the prenatal environment, determining the risks and rela- tive risks of e-cig use in pregnancy is timely and offers potential to impact the health of reproductive age women and their children.