New Zealand researchers are calling for a rethink of vaping advice during pregnancy after a new study found maternal vaping may be linked to Sudden Unexpected Death in Infancy, particularly when combined with bed sharing.
The study examined 101 SUDI deaths in Aotearoa during 2022 and 2023, with detailed information available on maternal nicotine exposure and infant sleep environments in 66 cases.
Among those cases, smoking and/or vaping was reported in nearly three-quarters, while almost 70 percent of infants died while directly bed sharing.
Maternal vaping was reported in half of SUDI cases involving direct bed sharing, compared with around one in five cases where direct bed sharing was not reported.
Researchers say the pattern is concerning because the interaction between maternal smoking and bed sharing is already well established as a major SUDI risk.
The new findings raise the possibility that nicotine exposure itself, rather than simply the way nicotine is delivered, may play a role in making infants more vulnerable.
But the researchers are also stressing an important limitation.
The study does not prove vaping causes SUDI.
Instead, the authors say the findings are strong enough to justify a precautionary approach while further research is carried out.
NICOTINE EXPOSURE NOW UNDER THE MICROSCOPE
The study comes at a time when smoking during pregnancy has declined in New Zealand, but SUDI rates have not fallen at the same pace.
That has prompted researchers to look more closely at other forms of nicotine exposure.
Vaping has often been promoted as a safer alternative to smoking and as a cessation tool, including for some pregnant women.
But the researchers say pregnancy may need a different approach from general adult smoking cessation.
Nicotine crosses the placenta, can reduce foetal blood flow and is associated with lower birthweight.
The research team is now asking whether vaping exposure could also contribute to the kind of impaired arousal response already associated with tobacco exposure in infants.
BED SHARING REMAINS A MAJOR FACTOR
The findings also reinforce concerns around direct bed sharing when maternal nicotine exposure is present.
In the cases studied, 84.8 percent of deaths occurring during direct bed sharing involved maternal smoking or vaping.
That does not mean bed sharing alone caused those deaths.
But researchers say the combination of nicotine exposure and bed sharing deserves particular attention in public health messaging.
CALL FOR PREGNANCY-SPECIFIC SUPPORT
The research team is recommending a pregnancy-specific nicotine policy with being nicotine-free as the goal.
That would include coordinated support across addiction services, maternity care, SUDI prevention and family support.
The emphasis is not on punishment or blame.
Researchers say women who smoke or vape during pregnancy need practical support that reflects their circumstances and helps them move towards stopping nicotine use as early as possible.
That could mean stronger cessation support, clearer pregnancy-specific advice and more consistent messaging across the health system.
MORE RESEARCH NEEDED
The researchers say urgent further work is needed to establish the specific risks associated with vaping during pregnancy.
In the meantime, they argue vaping should be discouraged during pregnancy in the same way smoking is discouraged.
For whānau, the key message is that vaping may not be risk-free in pregnancy, particularly when combined with direct bed sharing.
And while the science is still developing, the researchers say the safest direction is clear.
Reduce nicotine exposure as early as possible and make sure wāhine and whānau have the support they need to do it.
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