ArticleBMJ open2022
Assessing tobacco smoke exposure in pregnancy from self-report, urinary cotinine and NNAL: a validation study using the New Hampshire Birth Cohort Study.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Intra-individual variability of urinary non-persistent chemical concentrations during pregnancy in the ECHO Cohort.Journal of exposure science & environmental epidemiology · 2026Article
- Biochemical verification of tobacco use in ICU patients using point-of-care urinary cotinine.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026Article
- Making Statistics Clinically Meaningful.Clinical epidemiology · 2026Review
- A Meta-Analysis of Urinary Cotinine Cut-Off Concentrations in Children Under Five Years for Assessing Environmental Tobacco Smoke Exposure.Tobacco use insights · 2026Review
- Carbon monoxide levels, smoking and adverse pregnancy outcomes.Acta obstetricia et gynecologica Scandinavica · 2025Article
- Tobacco and cannabis use among pregnant women with prenatal opioid use.Addictive behaviors · 2025Article
- Examination of DNA Methylation Patterns in Children Born Premature with Prenatal Tobacco Smoke Exposure.Toxics · 2025Article
- Article
- Environmental and dietary factors associated with urinary OH-PAHs in mid-pregnancy in a large multi-site study.Environmental research · 2025Article
- Bridging Differences in Cohort Analyses of the Relationship between Secondhand Smoke Exposure during Pregnancy and Birth Weight: The Transportability Framework in the ECHO Program.Environmental health perspectives · 2024Article
- Nicotine or marijuana vaping exposure during pregnancy and altered immune responses in offspring.Journal of environmental exposure assessment · 2024Article
- Epidemiologic Advances Generated by the Human Health Exposure Analysis Resource Program.Current epidemiology reports · 2023Article
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Authors and funding
9 authors.
Funding
Abstract
objectivesAccurate assessment of tobacco smoke exposure is key to evaluate its effects. We sought to validate and establish cut-offs for self-reported smoking and secondhand smoke (SHS) exposure during pregnancy using urinary cotinine and 4-(methylnitrosamino)-1-(-3-pyridyl)-1-butanol (NNAL) in a large contemporary prospective study from the USA, with lower smoking prevalence than has previously been evaluated.
designProspective birth cohort.
settingPregnancy clinics in New Hampshire and Vermont, USA.
participants1396 women enrolled in the New Hampshire Birth Cohort Study with self-reported smoking, urinary cotinine, NNAL and pregnancy outcomes. PRIMARY AND SECONDARY OUTCOME MEASURES: Cut-offs for urinary cotinine and NNAL concentrations were estimated from logistic regression models using Youden's method to predict SHS and active smoking. Cotinine and NNAL were each used as the exposure in separate multifactorial models for pregnancy outcomes.
resultsSelf-reported maternal smoking was: 72% non-smokers, 5.7% ex-smokers, 6.4% SHS exposure, 6.2% currently smoked, 10% unreported. Cotinine and NNAL levels were low and highly intercorrelated (r=0.91). Geometric mean cotinine, NNAL were 0.99 ng/mL, 0.05 pmol/mL, respectively. Cotinine cut-offs for SHS, current smoking were 1.2 ng/mL and 1.8 ng/mL (area under curve (AUC) 95% CI: 0.52 (0.47 to 0.57), 0.90 (0.85 to 0.94)). NNAL cut-off for current smoking was 0.09 pmol/mL (AUC=0.82 (95% CI 0.77 to 0.87)). Using cotinine and NNAL cut-offs combined gave similar AUC to cotinine alone, 0.87 (95% CI 0.82 to 0.91). Cotinine and NNAL gave almost identical effect estimates when modelling pregnancy outcomes.
conclusionsIn this population, we observed high concordance between self-complete questionnaire smoking data and urinary cotinine and NNAL. With respect to biomarkers, either cotinine or NNAL can be used as a measure of tobacco smoke exposure overall but only cotinine can be used to detect SHS.
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