the vaping epidemic and pregnancy - ui health care...10/1/2020 1 the vaping epidemic and pregnancy...
Post on 26-Jan-2021
1 Views
Preview:
TRANSCRIPT
-
10/1/2020
1
The Vaping Epidemicand Pregnancy
Donna Santillan, PhDRound tableOctober 15, 2020
Disclosures
Therapeutic strategies for the treatment of preeclampsiaPatent number: 9937182Abstract: Compositions and methods for treating preeclampsia in a subject in need thereof are disclosed.Issued in US and Europe.
Never smoked or used e‐cigarettes
1
2
-
10/1/2020
2
Objective
• Review trends and current research related to e‐cigarette use in pregnancy
Reducing Cigarette Use• Public health advancement to reduce cigarette smoking
• Drug Abuse Resistance Education (D.A.R.E) founded in 1983• Family Smoking Prevention and Tobacco Control Act (2009)
1950s Pro‐Cigarette Ad 1983 D.A.R.E. Founded 1998 The Truth CampaignTobacco Control Legal Consortium. Tobacco Product Marketing Restrictions. July 2009.
3
4
-
10/1/2020
3
Cigarette use by adults has declined.
Cigarette use during pregnancy leads to an increased risk of:• miscarriage• placental abruption• ectopic pregnancy• placenta previa• premature lung development• abnormal brain development• low birth weight• premature birth• birth defects of the mouth and lip• sudden infant death syndrome “But… what if I switch to e‐cigarettes instead?”
Roelands J, Jamison MG, Lyerly AD, James AH. Consequences of smoking during pregnancy
on maternal health. Journal of women's health. 2009;18:867‐872
5
6
-
10/1/2020
4
One pack of cigarettes
20 cigarettes 1 pod
Is vaping safe?
There are no long‐term studies to back up claims that the vapor from e‐cigarettes is less harmful than conventional smoke.
Little is known about long‐term health effects.
59 deaths Over 2600 vaping related lung illnesses
7
8
-
10/1/2020
5
The issue with Flavorings• Appeal to kids• Meant to digest, not inhale
• After exposing cultured endothelial cells to high doses of:• menthol (mint)• acetylpyridine (burnt flavor)• vanillin (vanilla)• cinnamaldehyde (cinnamon)• eugenol (clove)• diacetyl (butter)• dimethylpyrazine (strawberry)• isoamyl acetate (banana)• eucalyptol (eucalyptus)
Cell deathandReactive oxygen species production, decreased nitric oxide
Arteriosclerosis, Thrombosis, and Vascular Biology, 2018
E‐Cigarette Use in Pregnancy
Liu B, Xu G, Rong S, Santillan DA, Santillan MK, Snetselaar LG, Bao W. JAMA Pediatrics. 173(6) June 2019
Buyun Liu, PhD
Wei Bao MD, PhD
9
10
-
10/1/2020
6
Prevalence among
Reproductive Age Women
Liu B, Xu G, Rong S, Santillan DA, Santillan MK, Snetselaar LG, Bao W. JAMA Pediatrics. 173(6) June
2019
Perceptions of Vaping in Pregnancy
57%
Journal of Addiction Medicine: July/August 2015 ‐ Volume 9 ‐ Issue 4 ‐ p 266–272
contain nicotine
61%
be addictive
43%
safer for fetus
74 %
safer for mother
72%
helps smoking cessation
11
12
-
10/1/2020
7
Smoking is underreported in pregnancy20% of pregnant smokers lie
about their habit
Journal of Addiction Medicine: July/August 2015 ‐ Volume 9 ‐ Issue 4 ‐ p 266–272
Reported vaping in pregnancy
• 2015 PRAMS (Pregnancy Risk Assessment Monitoring System) data
• Population based surveillance system of self reported behavior
• N=3277 women
Kapaya M, D’Angelo DV, Tong VT, et al. Use of Electronic Vapor Products Before, During, and After Pregnancy Among Women with a Recent Live Birth —Oklahoma and Texas, 2015. MMWR Morb Mortal Wkly Rep 2019;68:189–194.
13
14
-
10/1/2020
8
Kapaya M, D’Angelo DV, Tong VT, et al. Use of Electronic Vapor Products Before, During, and After Pregnancy Among Women with a Recent Live Birth —Oklahoma and Texas, 2015. MMWR Morb Mortal Wkly Rep 2019;68:189–194.
Kapaya M, D’Angelo DV, Tong VT, et al. Use of Electronic Vapor Products Before, During, and After Pregnancy Among Women with a Recent Live Birth —Oklahoma and Texas, 2015. MMWR Morb Mortal Wkly Rep 2019;68:189–194.
15
16
-
10/1/2020
9
Effects of Nicotine in Pregnancy
• In a Swedish study of 600,000 pregnancies, the use of e‐cigarettes in pregnancy was associated with a higher incidence of neonatal apnea than conventional cigarette use
• Prenatal nicotine exposure increases number of airways with small diameter (longer more tortuous airways)
• Mechanisms for this may involve increases α7 nicotinic acetylcholine receptors (nAChRs)
17
18
-
10/1/2020
10
Message from Pro‐Vaping Website
https://vaping360.com/learn/vaping‐vs‐smoking‐is‐vaping‐bad‐for‐you/
Summary of Effects of nicotine on pregnancyCategory Effect Smoke
ExposureNicotine Exposure
Pulmonary Function
Decreased forced expiratory flowDecreased complianceAltered flow ratio
YesYesYes
YesMaybeUnknown
Respiratory Illness
Increased Airway Reactivity/asthma/wheezeDecreased arousal/increased apneaIncreased respiratory infxns/hospitalizations/altered immune function
YesYesYes
YesYesYes
Anatomic and Cellular Changes
Increased connective tissue/airway wall thickeningIncreased narrow and smaller airwaysAltered alveolar geometryIncreased type 2 cells/surfactantIncreased NEB/PNEC
YesYesYesYesYes
YesYesYesYesYes
General Decreased birth weightPrematurity
YesYes
NoYes
Adapted from Spindel and McEvoy American Journal of Respiratory and Critical Care Medicine Vol. 193, No. 5 | Mar 01, 2016
19
20
-
10/1/2020
11
Can you breastfeed and vape?
• Because of the many benefits breastfeeding has for infants and moms, the American Academy of Pediatrics and the American College of Obstetrics and Gynecologists recommend breastfeeding even if the mother continues to use e‐cigarettes.
• Nicotine may lower breastmilk supply.
Current Research
21
22
-
10/1/2020
12
HypothesisE‐cigarettes will have negative effects at least as significant as those caused by traditional cigarettes
1) cell counts2) cytokine expression
changes3) cell migration & invasion
Why?
• E‐cigarettes contain nicotine• Even e‐cigarettes that claim to be nicotine‐free, have nicotine (60‐85%)
23
24
-
10/1/2020
13
Model Systems
• Placental and fetal lung cell lines
Cell Culture
Placental Tissue Explants
Primary Trophoblasts
Preparation of cigarette smoker’s media (CSE)
• 3R4F research grade cigarettes• Combust a full cigarette and bubble the smoke through 10 ml of cell media using a 60 ml syringe and tubing.
• The newly impacted media is then filtered through a 0.22 um pore membrane (Millipore). This method is termed “100% cigarette smoke extract (CSE).”
25
26
-
10/1/2020
14
Preparation of e‐cigarette smoker’s media (eCSE)
Experimental Groups
• Control: normal cell culture media
• CSE: research grade cigarettes in media at 0.5% and 4.5%
• eCSE: Juul pods (mint, menthol, Virginia tobacco) in media at 0.5% and 4.5%
27
28
-
10/1/2020
15
Effect of CSE vs. eCSE Media on
HTR8sv/Neo Cells
Effect of CSE vs. eCSE Media on
HTR8sv/Neo Cells
29
30
-
10/1/2020
16
0
10
20
30
40
50
60
0.5CSE 0.5eCSE 4.5CSE 4.5eCSE control
pg/m
l
IL6 Secretion
24h 48h
Cell Migration & Invasion Assay
31
32
-
10/1/2020
17
33
34
-
10/1/2020
18
Conclusions (Preliminary)
Placental cell numbers are reduced in a dose‐dependent manner upon exposure to CSE and eCSE
IL6 secretion is increased at 24h with CSE exposure and 48h with CSE and eCSE
Is it legal in Iowa?
•Legal age is 18
•Ames: banned in all enclosed workplaces, including bars and restaurants
•Coralville: banned in all enclosed workplaces, including bars and restaurants
•Iowa City: banned in all enclosed workplaces, including bars and restaurants or selling to minors
•North Liberty: banned in all enclosed workplaces, including bars and restaurants
35
36
-
10/1/2020
19
Funding Acknowledgements
• Children’s Miracle Network• NIEHS Grant• University of Iowa Center for Research by Undergraduates
Collaborators
• Hannah Slowey• Emily Leibold
• Wei Bao MD, PhD• Mark Santillan MD, PhD• Sabrina Scroggins, PhD• Vernat Exil MD, MBA• Eric Devor, PhD
37
38
-
10/1/2020
20
Questions
39
top related