Advertisement

Canadian Journal of Public Health

, Volume 88, Issue 4, pp 232–237 | Cite as

A Canadian Tertiary Care Centre Study of Maternal and Umbilical Cord Cotinine Levels as Markers of Smoking During Pregnancy: Relationship to Neonatal Effects

  • Sherry L. PerkinsEmail author
  • Judy M. Belcher
  • John F. Livesey
Article

Abstract

This study describes the prevalence of smoking among 3,220 pregnant women. Maternal and umbilical cord cotinine levels were compared with the women’s self-reported cigarette consumption, infant birth weight and antepartum and perinatal complications. Of the women who reported themselves as being active smokers (23%), 76% had a partner who smoked, and 38% reported exposure to environmental smoke in the workplace. Only 15% of nonsmokers had a partner who smoked, and 13% reported workplace exposure. The mean number of cigarettes/day was 20.5 (95% CI 19.6-21.4). The relative risk of having a small-for-gestational-age infant was significantly higher in smokers for mothers of both preterm (34-36 wks, RR= 3.38, 95% CI 1.25 - 9.16) and term babies (>- 37wks, RR= 2.04, 95% CI 1.58 - 2.63). Mean infant birth weight was 207 g lighter in the infants of smokers (p<0.001) and was inversely correlated to maternal serum cotinine level. Birth weight dropped by 0.99 g for every 1 ug/L increase in cotinine (r =-0.19, p<0.01).

Abrégé

Cette étude décrit la prévalence du tabagisme durant la grossesse, auprès de 3 220 Canadiennes. Les taux sanguins de cotinine de la mère et du cordon ombilical ont été comparés à la consommation de cigarettes déclarés par les participantes, au poids des nourrissons à la naissance et aux complications périnatales et postnatales. Parmi celles qui avouaient fumer activement (23 %), 76 % avaient un conjoint fumeur et 38 % étaient exposées à la fumée dans leur milieu de travail. Seulement 15 % des non fumeuses cohabitaient avec un fumeur, et 13 % rapportèrent être exposées à la fumée dans leur milieu de travail. La consommation moyenne s’élevait à 20,5 cigarettes/jour (95 % IC; 19,6 - 21,4). Le risque relatif de donner naissance à un bébé de petit poids prématuré (34-36 semaines; RR = 3,38; 95 % IC 1,25 - 9,16) ou à terme (>- 37 semaines; RR = 2,04; 95 % IC 1,58 - 2.63) était significative-ment plus élevé chez les fumeuses. Le poids moyen des nourrissons à la naissance issus de mères fumeuses était de 207 g inférieur à celui des nourrissons de mères non fumeuses (p<0,001), et était inversement proportionnel aux taux sanguins maternels de cotinine. En fait, le poids des nourrissons à la naissance diminuait de 0,99 g pour chaque augmentation de 1 μg/L de cotinine sanguin chez la mère (r = - 0,19; p<0,01).

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Feldman PR. Smoking and healthy pregnancy: Now is the time to quit. Md Med J 1985;34:982–86.PubMedGoogle Scholar
  2. 3.
    Meyer MB, Tonascia JA. Maternal smoking, pregnancy complications, and perinatal mortality. Am J Obstet Gynecol 1977;128:494–502.CrossRefGoogle Scholar
  3. 4.
    Fielding JE. Smoking and pregnancy. N Engl J Med 1978; 298:337–39.CrossRefGoogle Scholar
  4. 5.
    Mochizuki M, Maruo T, Masuko K, Ohtsu T. Effects of smoking on fetoplacental-maternal system during pregnancy. Am J Obstet Gynecol 1984;149:413–20.CrossRefGoogle Scholar
  5. 6.
    Cliver SP, Goldenberg RL, Cutter GR, Hoffman HJ, Davis RO, Nelson KG. The effect of cigarette smoking on neonatal anthropometric measurements. Obstet Gynecol 1995;85:625–30.CrossRefGoogle Scholar
  6. 7.
    Chelmow D, Andrew ED, Baker ER. Maternal cigarette smoking and placenta previa. Obstet Gynecol 1996;87:703–6.CrossRefGoogle Scholar
  7. 8.
    Ernster VL. Women and smoking. Am J Public Health 1993;83:1202–3.CrossRefGoogle Scholar
  8. 9.
    Camilli AE, McElroy LR, Reed KL. Smoking and pregnancy: A comparison of Mexican-American and non-Hispanic white women. Obstet Gynecol 1994;84:1033–37.PubMedGoogle Scholar
  9. 10.
    Williamson DF, Serdula MK, Kendrick JS, Binkin NJ. Comparing the prevalence of smoking in pregnant and nonpregnant women, 1985–1986. JAMA 1989;261:70–4.CrossRefGoogle Scholar
  10. 11.
    Smoking behaviour of Canadians: A national alcohol and other drugs survey report 1989. Ottawa: Health and Welfare Canada, 1992.Google Scholar
  11. 12.
    Mittendorf R, Herschel M, Williams MA, Hibbard JU, Moawad AH, Lee K-S. Reducing the frequency of low birth weight in the United States. Obstet Gynecol 1994;83:1056–59.CrossRefGoogle Scholar
  12. 13.
    Sexton M, Hebel JR. A clinical trial of change in maternal smoking and its effect on birth weight. JAMA 1984;251:911–15.CrossRefGoogle Scholar
  13. 14.
    Kendrick JS, Zahniser SC, Miller N, et al. Integrating smoking cessation into routine public prenatal care: The Smoking Cessation in Pregnancy Project. Am J Public Health 1995;85:217–22.CrossRefGoogle Scholar
  14. 15.
    Li CH, Windsor RA, Perkins L, Goldenberg RL, Lower JB. The impact on infant birth weight and gestational age of cotinine-validated smoking reduction during pregnancy. JAMA 1993;269:1519–24.CrossRefGoogle Scholar
  15. 16.
    Peacock JL, Bland JM, Anderson HR, Brooke OG. Cigarette smoking and birthweight: Type of cigarette smoked and a possible threshold effect. Int J Epidemiol 1991;20:405.CrossRefGoogle Scholar
  16. 17.
    Cnattingius S, Forman MR, Berendes HW, Graubard BI, Isotalo L. Effect of age, parity and smoking on pregnancy outcome: A population-based study. Am J Obstet Gynecol 1993;168:16–21.CrossRefGoogle Scholar
  17. 18.
    Perez-Stable EJ, Marin G, Marin BV, Benowitz NL. Misclassification of smoking status by self-reported cigarette consumption. Am Rev Respir Dis 1992;145:53–7.CrossRefGoogle Scholar
  18. 19.
    Emmons KM, Abrams DB, Marshall R, et al. An evaluation of the relationship between self-report and biochemical measures of environmental tobacco smoke exposure. Prev Med 1994;23:35–9.CrossRefGoogle Scholar
  19. 20.
    Ahijevych KL, Wewers ME. Patterns of cigarette consumption and cotinine levels among African American women smokers. Am J Respir Crit Care Med 1994; 150:1229–33.CrossRefGoogle Scholar
  20. 20.
    Patrick DL, Cheadle A, Thompson DC, et al. The validity of self-reported smoking: A review and meta-analysis. Am J Public Health 1994;84:1086–93.CrossRefGoogle Scholar
  21. 22.
    Perez-Stable EJ, Benowitz NL, Marin G. Is serum cotinine a better measure of cigarette smoking than self-report? Prev Med 1995:24;171–79.CrossRefGoogle Scholar
  22. 23.
    Riboli E, Haley NJ, Tredaniel J, et al. Misclassification of smoking status among women in relation to exposure to environmental tobacco smoke. Eur Respir J 1995;8:285–90.CrossRefGoogle Scholar
  23. 24.
    Perkins SL, Livesey JF, Escares E, Belcher J, Dudley DK. High-performance liquid-chromato-graphic method compared with a modified radioimmunoassay of cotinine in plasma. Clin Chem 1991;37:1989–93.PubMedGoogle Scholar
  24. 25.
    Arbuckle TE, Sherman GJ. An analysis of birth weight by gestational age in Canada. Can Med AssocJ 1989;140:157–65.Google Scholar
  25. 26.
    Benowitz NL, Kuyt F, Jacob P, Jones RT, Osman A-L. Cotinine disposition and effects. Clin Pharmacol Ther 1983;34:604–11.CrossRefGoogle Scholar
  26. 27.
    Luck W, Nau H, Hansen R, Steldinger R. Extent of nicotine and cotinine transfer to the human fetus, placenta and amniotic fluid of smoking mothers. Dev Pharmacol Ther 1985;8:384–95.CrossRefGoogle Scholar
  27. 28.
    Donnenfeld AE, Pulkkinen A, Palomaki GE, Knight GJ, Haddow JE. Simultaneous fetal and maternal cotinine levels in pregnant women smokers. Am J Obstet Gynecol 1993;168:781–2.CrossRefGoogle Scholar
  28. 29.
    Haddow JE, Knight GJ, Palomaki GE, McCarthy JE. Second-trimester serum cotinine levels in nonsmokers in relation to birth weight. Am J Obstet Gynecol 1988;159:481–84.CrossRefGoogle Scholar
  29. 30.
    Eskenazi B, Prehn AW, Christianson RE. Passive and active maternal smoking as measured by serum cotinine: The effect on birth weight. Am J Public Health 1995;85;395–8.CrossRefGoogle Scholar
  30. 31.
    Bardy AH, Seppala T, Lillsunde P, et al. Objectively measured tobacco exposure during pregnancy: Neonatal effects and relation to maternal smoking. Br J Obstet Gynaecol 1993;100:721–26.CrossRefGoogle Scholar
  31. 32.
    Haddow JE, Knight GJ, Palomaki GE, Kloza EM, Wald NJ. Cigarette consumption and serum cotinine in relation to birth weight. Br J Obstet Gynaecol 1987;94:678–81.CrossRefGoogle Scholar
  32. 33.
    Rebagliato M, Florey C du V, Bolumar F. Exposure to environmental tobacco smoke in nonsmoking pregnant women in relation to birth weight. Am J Epidemiol 1995;142:531–37.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 1997

Authors and Affiliations

  • Sherry L. Perkins
    • 1
    • 3
    Email author
  • Judy M. Belcher
    • 2
  • John F. Livesey
    • 1
  1. 1.Department of Laboratory MedicineOttawa Civic HospitalCanada
  2. 2.Department of Obstetrics and GynecologyOttawa Civic HospitalCanada
  3. 3.Department of Pathology and Laboratory MedicineUniversity of OttawaCanada

Personalised recommendations