Maternal & Infant Health Benefits of a Nicotine Product Standard in the United States

ImportanceCigarette smoking during pregnancy increases the risks of miscarriage, ectopic pregnancy, placental complications, hypertensive disorders of pregnancy, and infant mortality. Reducing smoking in pregnancy remains a pressing public health priority. ObjectiveTo project the impact of a proposed nicotine product standard on maternal complications and infant mortality using the Smoking, E-cigarette use, and Pregnancy (SEP) microsimulation model. Design, Settings, and ParticipantsIndividual-level, annual-cycle microsimulation of U.S. females of reproductive age that tracks smoking, vaping, pregnancy, and pregnancy outcomes was constructed. Model inputs were drawn from national surveillance and vital statistics, including National Health Interview Survey (NHIS) for general population, Behavioral Risk Factor Surveillance System (BRFSS) (2016-2023) for smoking/vaping among pregnant women and NVSS Natality/Linked Birth-Infant Death files for late-pregnancy morbidities and infant mortality. Policy effects on tobacco and e-cig usage transitions are based on FDAs expert-elicitation and used to simulate outcomes under status quo vs. the new policy from 2027-2100. ExposureSmoking and vaping. Main Outcome(s)Maternal outcomes during pregnancy (ectopic pregnancy, miscarriage, placenta previa, placental abruption, hypertensive disorders of pregnancy/pre-eclampsia, eclampsia), infant mortality, pregnancy-related costs, and maternal Quality Adjusted Life Years (QALYs). ResultsUnder the nicotine product standard (policy start 2027), smoking in pregnancy falls sharply from 6.0% in 2027 to 1.2% by 2040. These behavioral shifts translate into large perinatal gains through 2100: approximately 167,000 ectopic pregnancies, 950,000 miscarriages, 15,000 placenta previa, 62,000 placental abruptions, 167,000 hypertensive disorders of pregnancy/pre-eclampsia, 9,000 eclampsia cases, and 64,000 infant deaths are averted cumulatively. Maternal health improves as well, with 103,000 pregnancy QALYs gained. Health system spending falls despite conservative costing, with $4.9 billion in pregnancy-related medical costs avoided. Across uncertainty bounds, direction and magnitude of benefit remain favorable for all maternal morbidities and infant deaths, indicating that new policy yields substantial and durable health gains alongside meaningful cost offsets. ConclusionsA proposed nicotine product standard is projected to improve maternal and infant outcomes and yield sizable pregnancy-related health gains and cost offsets. The SEP model complements prior tobacco policy evaluation frameworks while focusing on maternal and infant health.