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Introduction Smoking in pregnancy increases the risk of negative health outcomes. Vaping can be effective for smoking cessation in nonpregnant populations. We conducted a systematic review of vaping in pregnancy, covering prevalence, patterns of use, reasons for use, smoking cessation, and health effects. Methods Five academic databases were searched on 17 February 2020. Studies reporting prevalence, patterns, reasons, cessation, or health effects of vaping in pregnancy were included; animal and in vitro studies were excluded. A narrative review was used, with risk of bias assessed using Hoy and colleague’s tool, the Newcastle–Ottawa scale, and the Consolidated Criteria for reporting Qualitative Research. Results Twenty-three studies were identified: 11 survey, 7 qualitative, 3 cohort, and 2 secondary analyses of randomized clinical trials. Prevalence of vaping in pregnancy (four studies) was between 1.2% and 7.0% overall, and Conclusions There were insufficient data to draw conclusions about prevalence, patterns, and effects of vaping in pregnancy on smoking cessation. The limited literature suggests that vaping in pregnancy has little or no effect on birthweight. Implications Smoking causes many negative health outcomes for pregnant women and to babies born to people who smoke. There remains a paucity of research on the effects of vaping in pregnancy. There is, however, the potential for vaping products to reduce the negative health outcomes associated with smoking. More research is needed to develop an evidence base in this area.

McKee and Capewell recently criticised Public Health England’s position on e-cigarettes (ECs)1 and our underlying report2 in the Lancet ,3 the media,4 and now The BMJ .5 Their statement “directors of public health and the wider community desperately need advice on EC that is evidence based and free from any suspicion of influence by vested interests”5 is offensive. We have an extensive track record of research dedicated to understanding smoking behaviour and population and individual approaches to help smokers stop and prevent uptake of smoking; we have published hundreds of primary research articles on smoking, nicotine, and ECs; and we have years of clinical experience in smoking cessation. We have never taken any tobacco or EC industry funds. By contrast, McKee and Capewell are not experts in this field—they have carried out no nicotine dependence, smoking cessation, or EC …

The Lancet Editorial criticises our Public Health England commissioned evidence update report on the basis of perceived flaws in one of the 185 references we used, ignoring the rest of our 111 page document, which addresses population effects of e-cigarette use, regulations, attitudes as well as concerns over its safety. The Editorial focuses on the estimate of risk reduction and protests strongly against the media reassuring smokers that switching to e-cigarettes provides substantial health benefits, but it provides no data to counter our estimate, nor any reason as to why The Lancet believes that the message smokers can benefit from switching to vaping is an undesirable one. The estimate that e-cigarette use is around 95% less harmful than smoking is based on the facts that: first, cigarette smoke constituents that harm health are either absent in e-cigarette vapour or, if present, are mostly at levels much below 5% of smoking doses; and second, the main chemicals present in e-cigarettes only have not been associated with any serious risk. Our review highlighted how smokers are currently misinformed about these relative risks. We would encourage people to read our full report before criticising it. Current evidence indicates that smokers who switch from smoking to e-cigarettes reduce the risks to their health dramatically. We believe this needs to be communicated and that undermining this message will keep smokers smoking and dying as a result.