Evaluating the Accuracy of Self-Reported Exposure to Secondhand Smoke during Pregnancy by Measuring Umbilical Cord Blood Cotinine Concentration
DOI:
https://doi.org/10.22100/jkh.v9i2.454Keywords:
Exposure to tobacco smoke, Pregnancy, Cord blood cotinine.Abstract
Introduction: Exposure to secondhand smoke (SHS) during pregnancy leads to fetal and neonatal complications. Since the effect of exposure to tobacco smoke during pregnancy on maternal self-reporting may not be accurate, this study design to evaluate the validity and accuracy of maternal self- reported SHS exposure, using the cord blood cotinine as a biomarker of exposure to tobacco at delivery.
Methods: This was a cross-sectional study conducted on 108 non-smoking pregnant women. They were divided into two groups based on their reports; smoke exposed (54) and non-exposed groups (54). Exposure to tobacco smoke was assessed during pregnancy by measuring cord blood cotinine and using questionnaires. The umbilical cord blood of newborns was obtained at delivery room to evaluate the amount of cotinine (main metabolite of nicotine) and for estimation of the accuracy of maternal self-reported to SHS exposure, cut-off point Cotinine level of umbilical cord serum that more than 2 ng/ml was considered as positive exposed.
Result: The geometric mean cotinine of umbilical cord serum in the exposed group (3.71±1.22 ng/ml) was significantly higher than the non-exposed (0.404±0.63 ng/ml) (P<0.0001). There was a strong association between maternal reported SHS exposure and umbilical cord cotinine (Kappa= 98%, P<0.0001). In addition, the reported SHS exposure had 98% sensitivity, 100% specificity, 100% positive and 98% negative predictive value in comparison to umbilical cord cotinine concentration.
Conclusion: This study shows that maternal self-reported SHS exposure is highly accurate .Moreover it seems valid questionnaire. Should be considered as an alternative method for measuring chemical biomarkers, such as cotinine; if the structured questionnaires and accurate interviewing techniques is used.
References
England LJ, Kendrick JS, Gargiullo PM Zahniser SC, Hannon WH. Measure of maternal tobacco exposure and infant birth weight at term. Am J Epidemiol 2003;157(1):86-7.
U.S Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta , G.A: U.S Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Human Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health 2006.
World Health Organization. WHO report on the global tobacco epidemic, The MPOWER package, fresh and alive 2008. Retrive July 2009, from http://www.who.int/entity/tobacco/mpower/ mpower_report_full_2009.pdf.
Jeyabalan A, Powers R, Durica A, Harger G, Roberts J, Ness R. Cigarette smoke exposure and angiogenic factors in pregnancy and preeclampsia. American Journal of Hypertension 2008;21(8):943-947.
Seong MW, Hwang JH, Moon JS, Ryu HJ, Kong SY, Um TH, et al. Neonatal hair nicotine levels and fetal exposure to paternal smoking at home. Am J Epidemiol 2008;168(10):1140-1144.
Park EY, Hong YC, Lee KH, Im MW, Ha E, Kim YJ, et al. Maternal exposure to environmental tobacco smoke, GSTM1/T1 polymorphisms and oxidative stress. Reprod Toxicol 2008;26(3-4):197-202.
Ward C, Lewis S, Coleman T. Prevalence of maternal smoking and environmental tobacco smoke exposure during pregnancy and impact on birth weight: retrospective stud using Millennium Cohort. BMC Public Health 2007;781.
Chen R, Tunstall-Pedoe H, Tavendale R. Environmental tobacco smoke and lung function in employees who never smoked: the Scottish MONICA study. Occupational And Environmental Medicine 2001;58(9);563-568.
Nakamura MU, Alexandre SM, Kuhn Dos Santos JF, de Souza E, Sass N, Auritscher Beck AP, et al. Obstetric and perinatal effects of active and/or passive smoking during pregnancy. Sao Paulo Med J 2004 May 6;122(3):94-8.
Yao T, Lee A, Mao Z. Potential unintended consequences of smoke-free policies in public places on pregnant women in China. American Journal of Preventive Medicine 2009;37(2):S159-S164.
Baheiraei A, Faghihirad S, Mirmohamadali M, kazemnejad A. Predictors of home smoking ban in households in pregnant women. Payesh 2012;11(4):309-416.[Persian].
Benowitz NL. Biomarkers of environmental tobacco smoke exposure. Environ Health Perspect 1999;107:349-55.
Britton G, Brinthaupt J, Stehle J, James G. Comparison of self-reported smoking and urinary cotinine levels in a rural pregnant population. Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN 2004;33(3):306-311.
Chiu H, Isaac Wu H, Kuo H. The relationship between self-reported tobacco exposure and cotinines in urine and blood for pregnant women. The Science of The Total Environment 2008; 406(1-2):331-336.
Chou S, Hsu H, Kuo HH, Kuo HW. Association between exposure to environmental tobacco smoke (ETS) and breastfeeding behaviour. Acta Paediatr 2008;97(1):76-80.
Dempsey D, Jacob P, Benowitz N. Accelerated metabolism of nicotine and cotinine in pregnant smokers. The Journal of Pharmacology and Experimental Therapeutics 2002;301(2):594-598.
Blake SM, Murray KD, El-Khorazaty MN, Gantz MG, Kiely M, Best D, et al. Environmental tobacco smoke avoidance among pregnant African-American nonsmokers. Am J Prev Med 2009;36(3):225-234.
Wu F, Chiu H, Wu H, Lin C, Lai J, Kuo H. Comparison of urinary and plasma cotinine levels during the three trimesters of pregnancy. Paediatric and Perinatal Epidemiology 2008;22(3): 296-301.
Hanke W, Sobala W, Kalinka J. Environmental tobacco smoke exposure among pregnant women: impact on fetal biometry at 20-24 weeks of gestation and newborn child's birth weight. International Archives of Occupational and Environmental Health 2004;77(1):47-52.
Klein J, Blanchette P, Koren G. Assessing nicotine metabolism in pregnancy-a novel approach using hair analysis. Forensic Science International 2004;145(2-3):191-194.
Diaz-Gomez NM, Mendoza C, González-González NL, Barroso F, Jimenez-Sosa A, Domenech E, et al. Maternal smoking and the vitamin D-parathyroid hormone system during the perinatal period. The Journal of Pediatrics 2007;151(6):618-623.
Pickett K, Rathouz P, Kasza K, Wakschlag L, Wright R. Self-reported smoking, cotinine levels, and patterns of smoking in pregnancy. Paediatric and Perinatal Epidemiology 2005;19(5):368-376.
Jhun H, Seo H, Lee D, Sung M, Kang Y, Syn H, et al. Self-reported smoking and urinary cotinine levels among pregnant women in Korea and factors associated with smoking during pregnancy. Journal of Korean Medical Science 2010;25(5):752-757.
Paek Y, Kang J, Myung S, Lee D, Seong M, Seo H, et al. Self-reported exposure to second-hand smoke and positive urinary cotinine in pregnant nonsmokers. Yonsei Medical Journal 2009;50 (3):345-351.
Baheiraei A, Kharaghani R, Mohsenifar A, Kazemnejad A, Mota A, Sharifi Milani H, et al. Factors associated with secondhand smoke exposure in infants. Tanaffos 2010;9(2):43-49.
Jedrychowski W, Perera F, Mroz E, Edwards S, Flak E, Bernert J, et al. Fetal exposure to secondhand tobacco smoke assessed by maternal self-reports and cord blood cotinine: prospective cohort study in Krakow. Maternal and Child Health Journal 2009;13(3): 415-423.
Sadler L, Belanger K, Saftlas A, Leaderer B, Hellenbrand K, McSharry JE, et al. Environmental tobacco smoke exposure and small-for-gestational-age birth. Am J Epidemiol 1999;150(7):695-705.
Pirkle J, Bernert J, Caudill S, Sosnoff C, Pechacek T. Trends in the exposure of nonsmokers in the U.S. population to secondhand smoke: 1988-2002. Environmental Health Perspectives 2006; 114(6):853-858.
Mascola MA, Van Vunkins H, Tager IB, Speizer FE, Hanrahan JP. Exposure of youbg infants to environmental tobacco smoke: breast-feeding among smoking mothers. American Journal of Public Health 1998;88:893-896.
McDonald S, Perkins S, Walker M. Correlation between self-reported smoking status and serum cotinine during pregnancy. Addictive Behaviors 2005;30(4):853-857.
Klebanoff MA, Levien RJ, Morris CD, Hauth JC, Sibai BM, Ben Curet L, et al. Accuracy of self- reported cigarette smoking among pregnant woman in the 1990s. US Government Paediatric and Perinatal Epidemiolog 2001;15:140-143.
Sadat Z, Bazarganipour F, Sehhat Z, Barati M. The relationship between maternal environmental tobacco smoke exposure during pregnancy with anthropometric parameters of the newborn. Journal of Qom University of Medical Sciences 2009;2:35-42.[Persian].
Negahban T, Rezaeian M, Ansari A, Asami Z, Zareei T. Passive smoking during pregnancy and obstetric outcomes in pregnant women referring to rafsanjan nicknafs hospital. Journal of Rafsanjan University of Medical Sciences 2010;9:281-292. [Persian].
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