The detrimental effects of cigarette use during pregnancy are well documented. Studies have shown that cigarette smoking while pregnant is associated with multiple adverse outcomes including: pre-term birth, placental abruption, placenta previa, fetal growth restriction, stillbirth, increased rate of birth defects, and increased risk of sudden infant death syndrome. Cotinine is the primary metabolite of nicotine and allows for measurement of active as well as passive exposure. Cotinine freely cross the placental barrier and maternal concentrations are closely correlated with newborn plasma levels. The aim of this study was to compare maternally reported rates of tobacco use to fetal umbilical cord blood cotinine levels at the time of delivery. A cross-sectional study was conducted on 172 patients. Patients were asked a single yes or no question in regards to their cigarette use during pregnancy. Cord blood was collected at the time of delivery and analyzed for serum concentrations of cotinine. Cotinine levels greater than 3.0 ng/mL were considered consistent with the use of tobacco or tobacco cessation products. Maternal self-reporting of tobacco use indicates a reported tobacco use rate of 27.3% and an actual use rate of 30.2%. The reported tobacco non-use rate was 72.7% and the actual non-use rate was 66.3%. The prevalence of tobacco use during pregnancy in our study was 30.2%, while the overall rate in the United States is reported to be 12.3%. Our findings indicate that self-reported smoking prevalence and verified umbilical cord blood cotinine levels at the time of delivery have excellent correlation (kappa=0.76). Compared to the national average our study group also had nearly double the rate of tobacco use. Due to the deleterious effects of cigarette use during pregnancy continued efforts to educate patients regarding cigarette cessation is of utmost importance as cessation of tobacco products will improve and promote maternal and fetal well-being.
Conflict(s) of Interest
References with DOI
1. The Health Consequences of Smoking: A Report of the Surgeon General. Reports of the Surgeon General. Atlanta (GA)2004.
2. Bruin JE, Gerstein HC, Holloway AC. Long-term consequences of fetal and neonatal nicotine exposure: a critical review. Toxicol Sci. 2010;116(2):364-74. https://doi.org/10.1093/toxsci/kfq103
3. Cornelius MD, Day NL. Developmental consequences of prenatal tobacco exposure. Curr Opin Neurol. 2009;22(2):121-5. https://doi.org/10.1097/wco.0b013e328326f6dc
4. Heck JE, Contreras ZA, Park AS, Davidson TB, Cockburn M, Ritz B. Smoking in pregnancy and risk of cancer among young children: A population-based study. Int J Cancer. 2016;139(3):613-6. https://doi.org/10.1002/ijc.30111
5. Berlin I, Heilbronner C, Georgieu S, Meier C, Spreux-Varoquaux O. Newborns' cord blood plasma cotinine concentrations are similar to that of their delivering smoking mothers. Drug Alcohol Depend. 2010;107(2- 3):250-2. https://doi.org/10.1016/j.drugalcdep.2009.10.008
6. Laskowska-Klita T, Chelchowska M, Leibschang J. [Concentrations of cotinine in serum and urine of smoking pregnant women and in placenta and umbilical cord blood]. Przegl Lek. 2005;62(10):1007-9.
7. Tong VT, Dietz PM, Morrow B, D'Angelo DV, Farr SL, Rockhill KM, et al. Trends in smoking before, during, and after pregnancy--Pregnancy Risk Assessment Monitoring System, United States, 40 sites, 2000-2010. MMWR Surveill Summ. 2013;62(6):1-19.
8. Tong VT, Jones JR, Dietz PM, D'Angelo D, Bombard JM, Centers for Disease C, et al. Trends in smoking before, during, and after pregnancy - Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 31 sites, 2000-2005. MMWR Surveill Summ. 2009;58(4):1-29.
9. Ahmadi-Montecalvo H, Haile ZT, Umer A, Chertok IR. Adolescent Pregnancy and Smoking in West Virginia: Pregnancy Risk Assessment Monitoring System (PRAMS) 2005-2010. Matern Child Health J. 2016. https://doi.org/10.1007/s10995-016-2040-y
10. Benowitz NL, Bernert JT, Caraballo RS, Holiday DB, Wang J. Optimal serum cotinine levels for distinguishing cigarette smokers and nonsmokers within different racial/ethnic groups in the United States between 1999 and 2004. Am J Epidemiol. 2009;169(2):236-48. https://doi.org/10.1093/aje/kwn301
11. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med. 2005;37(5):360-3.
12. Nguyen KH, Marshall L, Brown S, Neff L. State-Specific Prevalence of Current Cigarette Smoking and Smokeless Tobacco Use Among Adults - United States, 2014. MMWR Morb Mortal Wkly Rep. 2016;65(39):1045-51. https://doi.org/10.15585/mmwr.mm6539a1
13. Agaku IT, King BA, Dube SR, Centers for Disease C, Prevention. Current cigarette smoking among adults - United States, 2005-2012. MMWR Morb Mortal Wkly Rep. 2014;63(2):29-34.
14. Klebanoff MA, Levine RJ, Clemens JD, DerSimonian R, Wilkins DG. Serum cotinine concentration and self-reported smoking during pregnancy. Am J Epidemiol. 1998;148(3):259-62. https://doi.org/10.1093/oxfordjournals.aje.a009633
15. Kvalvik LG, Nilsen RM, Skjaerven R, Vollset SE, Midttun O, Ueland PM, et al. Self-reported smoking status and plasma cotinine concentrations among pregnant women in the Norwegian Mother and Child Cohort Study. Pediatr Res. 2012;72(1):101-7. https://doi.org/10.1038/pr.2012.36
16. Force USPST. Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults a nd pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann I ntern Med. 2009;150(8):551-5. https://doi.org/10.7326/0003-4819-150-8-200904210-00009
17. Committee opinion no. 471: Smoking cessation during pregnancy. Obstet Gynecol. 2010;116(5):1241-4.
18. Committee on Health Care for Underserved W. Committee opinion number 503: tobacco use and women's health. Obstet Gynecol. 2011;118(3):746-50. https://doi.org/10.1097/aog.0b013e3182004fcd
19. McCowan LM, Dekker GA, Chan E, Stewart A, Chappell LC, Hunter M, et al. Spontaneous preterm birth and small for gestational age infants in women who stop smoking early in pregnancy: prospective cohort study. BMJ. 2009;338:b1081. https://doi.org/10.1136/bmj.b1558
20. England LJ, Kendrick JS, Wilson HG, Merritt RK, Gargiullo PM, Zahniser SC. Effects of smoking reduction during pregnancy on the birth weight of term infants. Am J Epidemiol. 2001;154(8):694-701. https://doi.org/10.1093/aje/154.8.694
Cottrell, Jesse; Mitchell, Brenda L.; Sangani, Pooja N.; Thomas, D'Andrea S.; and Valentovic, Monica A.
"Self-Reported Tobacco Use and Correlation with Umbilical Cord Blood Cotinine levels at Delivery among Appalachian Gravidas,"
Marshall Journal of Medicine:
1, Article 12.
Available at: http://mds.marshall.edu/mjm/vol3/iss1/12