Electronic Cigarettes During Pregnancy: Impact on Fetal Development

项目概要/摘要 虽然美国的香烟使用量有所下降，但电子烟的使用量却急剧增加。 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 （重新规范吸烟，电子液体的危险）与减少危害的潜力（“清洁”尼古丁输送系统， 不含烟草燃烧产物）。风险与减少危害的问题更加突出 妊娠期间，由于母体用药对母体和胎儿的影响， 发育中的胎儿对尼古丁和燃烧产物的敏感性。最近公布的报告显示， 孕妇中电子烟使用率为4-15%;我们小组的试点数据显示，产前电子烟使用率翻了一番。 2012年至2017年期间使用的雪茄。鉴于孕妇使用电子烟的证据越来越多，已知的胎儿毒性- 尼古丁的危害，以及需要数据来告知孕妇和产科提供者，研究以阻止- 迫切需要研究电子烟对胎儿发育的影响和相对影响（与香烟相比）。 然而，到目前为止，还没有发表关于怀孕期间使用电子烟对胎儿发育影响的研究。 我是说。我们提出了第一个研究怀孕期间电子烟对胎儿发育的影响，在- 包括胎儿生长的标志物和胎儿大脑和神经行为发育的新测量。 我们的团队率先联合使用实时超声和胎儿心动图来表征胎儿 神经行为3D超声的出现提供了更高分辨率的胎儿图像，并允许体积特征， 胎儿大脑结构的特征。来自我们小组的精液初步数据强调了 招募怀孕的电子烟使用者以及胎儿生长、胎儿额小脑 电子烟使用者的大脑结构和胎儿神经行为发育。这项研究是一项深入的研究， 对三组母婴对进行前瞻性调查：电子烟使用者、吸烟者和对照组。理解- 胎儿生长、神经结构和神经行为发育的综合指标将在妊娠期间进行评估， 使用2D和3D超声检查，然后进行新生儿超声和神经行为评估。 还将评估母体和胎儿尼古丁、燃烧和致癌性生物标志物。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。我们还将探讨：（4）尼古丁 和毒性生物标志物与胎儿生长、脑和神经行为发育的关系。建议的研究报告， 解决了一个紧迫而悬而未决的公共卫生问题。随着电子烟使用率的提高， 发育中的胎儿对产前环境破坏的敏感性，确定风险和相关性， 怀孕期间使用电子烟的风险是及时的，并有可能影响生殖年龄的健康 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.