The relationship between self-reported tobacco exposure and cotinines in urine and blood for pregnant women
Introduction
The effects of tobacco smoke exposure on the health of pregnant women and neonates, including the birth outcomes, are of great interest in public health. However, it is not easy to evaluate the true exposure level. The common evaluation methods include questionnaire administration and biochemical assay of cotinine, a metabolite of nicotine, in urine, blood, hair, and saliva, etc. In the literature, exposure to environmental tobacco smoke (ETS) was assessed by a questionnaire administered to the women during and after pregnancy (Martin and Bracken, 1986, Armstrong et al., 1992, Lieberman et al., 1994, Källén, 2001). However, ETS measurement biases occurred due to the subjects' difficulty in recognizing smoking behavior or recalling exposure to secondhand smoke. Recently, the use of biomarkers for smoking and ETS exposure has improved the reliability and validity of assessments by self-reported questionnaires. Pichini et al. (2000) found that umbilical cord serum cotinine could be used as a biomarker for fetal exposure to cigarette smoke at the end of pregnancy. In addition, their findings indicated umbilical cord serum cotinine not only distinguished active smoking from passive smoking, but also exposure to ETS from non-exposure. However, this study was not designed for cut-off calculation due to the extreme closeness of the non-exposure group and the ETS exposure group. De Weerd et al. (2002) measured the variation of the serum and urine cotinine levels in passive and active smokers and applied them in pre-conceptional smoking cessation counseling. Both serum and urine cotinine assay could distinguish between passive and active smokers, but not between higher categories of smokers (10–19 and > 20 cigarettes per day) due to significant overlap in different subjects.
There are no standardized cut-off values for cotinine in the different specimens. In a Swedish study of pregnant women, a cut-off value of < 17.5 ng/ml cotinine in serum was used to define passive smokers, 17.6–113 ng/ml for light smokers, and > 113 ng/ml for smokers of more than 10 cigarettes a day (Lindquvist et al., 2002).Cotinine levels in umbilical cord serum was cut-off at 1 ng/ml to differentiate between exposure and non-exposure to ETS (Bearer et al., 1997). Although during pregnancy there is a higher correlation between maternal blood cotinine concentrations and adverse results than between self-reported smoking and such results, few studies have measured blood and urinary cotinine levels simultaneously at different trimesters in pregnant women. The objective of this study is to explore the relationship of self-reported exposure to tobacco smoke and the cotinine levels in the urine and blood over the follow-up period for pregnant women.
Section snippets
Subjects
The protocol was verified by the Institute of Review Board (IRB) at the China Medical University Hospital. All participants were enlisted from three medical centers in Taichung City and signed informed consent forms. Three hundred fourteen pregnant women agreed to participate during their first trimester, but of this group only 215 subjects participated during the second trimester, with a follow-up rate of 68.5%. In addition, 371 new subjects participated during the second trimester.
Results
The mean and median of urinary/plasma cotinine levels (ng/ml) based on self-reported exposure to tobacco smoke during the first trimester of pregnancy is shown in Table 1. Because the distributions were skewed to the right, the mean and median values of the urinary/plasma cotinine levels were not consistent between the groups. The grades were based on the median values. For urinary cotinine levels, the highest was in active smokers but not exposed to ETS. In general, urinary cotinine levels
Discussion
Previous studies have encountered difficulties and inconsistencies when defining ETS exposure. With no standardized criteria to follow, the participants in this study were interviewed and determined to have been exposed to ETS if they had been in the presence of tobacco smoke for a period of at least 1 h during pregnancy either at home or in the workplace. However, women exposed to ETS at other locations such as while commuting, at social occasions or other occasions were not covered in this
References (28)
- et al.
Variation of serum and urine cotinine in passive and active smokers and applicability in preconceptional smoking cessation counseling
Environ Res
(2002) - et al.
Assessment of smoking behaviors in the home and their influence on children's passive smoking: development of a questionnaire
Ann Epidemiol
(2005) - et al.
Determination of urinary and salivary cotinine using gas and liquid chromatography and enzyme-linked immunosorbent assay
J Chromatogr B
(2002) - et al.
Correlation between self-reported smoking status and serum cotinine during pregnancy
Addict Behav
(2005) - et al.
Rapid and sensitive high-performance liquid chromatographic determination of nicotine and cotinine in nonsmoker human and rat urines
J Chromatogr B
(1998) - et al.
Cigarette, alcohol, and coffee consumption and spontaneous abortion
Am J Publ Health
(1992) - et al.
A community study of smoking in pregnancy
J Obstet Gynascol Br Cwlth
(1972) - et al.
Maternal tobacco exposure and persistent pulmonary hypertension of the newborn
Environ Health Perspect
(1997) Cotinine as a biomarker of environmental tobacco smoke
Epidemiol Rev
(1996)- et al.
Development and validation of sensitive method for determination of serum cotinine in smokers and nonsmokers by liquid chromatography/atmospheric pressure ionization tandem mass spectrometry
Clin Chem
(1997)
Involuntary exposure to tobacco smoke in adolescents: urinary cotinine and environmental factors
Arch Environ Health
Cigarette smoking in pregnancy its influence on birth weight and perinatal morality
Br Med J
Measurement of current exposure to environmental tobacco smoke
Arch Environ Health
Passive and active maternal smoking as measured by serum cotinine: the effect on birthweight
Am J Public Health.
Cited by (35)
Psychometric Properties of the Short Form of the Health Practices Questionnaire–II Chinese Version
2019, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal NursingFactors associated with second-hand smoke exposure in non-smoking pregnant women in Spain: Self-reported exposure and urinary cotinine levels
2014, Science of the Total EnvironmentCitation Excerpt :It has less influence on the UC levels of the SHS exposure in places of leisure, at work and in restaurants. Chiu et al. (2008) and Kvalvik et al. (2012) observed that cotinine levels both in plasma and in urine were higher among women exposed to SHS at home than in those exposed at work. Rebagliato et al. (1995) reported higher cotinine levels in pregnant women exposed to SHS in public places, followed by exposure from a partner smoking, exposure at work and other sources.
Association of time-location patterns with urinary cotinine among asthmatic children under household environmental tobacco smoke exposure
2013, Environmental ResearchCitation Excerpt :Children are more intensely exposed to ETS than adults because of the higher relative breathing rates, which would lead to higher internal exposures, and children are also unable to prevent their own exposure from ETS (Ashley and Ferrence, 1998, Willers et al., 1995). However, it is difficult to precisely quantify this environmental exposure as it is significantly influenced by the child's daily activities (Chiu et al., 2008; Klepeis et al., 2001; Tsai et al., 2010). The Global Youth Tobacco Survey 2000–2007 by World Health Organization (WHO) revealed that 43.9% of children worldwide were exposed to ETS at home (2007).
Mother's environmental tobacco smoke exposure during pregnancy and externalizing behavior problems in children
2013, NeuroToxicologyCitation Excerpt :First, our assessment of ETS was based on women's self-report. The validity of self-reported ETS exposure is still a concern, although some studies, particularly recent studies in Asia, have found this methodology acceptable and useful (Chiu et al., 2008; Kaufman et al., 2002; Nondahl et al., 2005). The women were asked to recall exposures that happened 5–6 years ago, and thus recall bias could not be excluded.
Cytogenetic evaluation of pre-pregnancy smoking in maternal and newborn lymphocytes
2012, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Studies have found a strong association between maternal and newborn plasma cotinine concentrations, concluding that there is probably no placental barrier for plasma cotinine between pregnant mothers and their newborns. This lack of placental barrier for cotinine (and probably for nicotine) can partially explain smoking-related perinatal disorders [1,42–44]. Given that the smoking group in the present study consisted of mothers who quit smoking during pregnancy could lead to speculation.
Self-reported tobacco smoke exposure and plasma cotinine levels during pregnancy - A validation study in Northern Japan
2011, Science of the Total EnvironmentCitation Excerpt :In previous studies, having a husband or household members who smoker significantly affects SHS exposure (Loke et al., 2000; DeLorenze et al., 2002; Kaufman et al., 2002). Also, one study found higher plasma cotinine levels among non-smokers exposed at home than those exposed in the workplace (Chiu et al., 2008). Although the duration of exposure was only measured in terms of days and not hours in our study, a more detailed questionnaire could have improved the authenticity of self-reports.