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Pregnant nicotine exposure higher than reported
The study reveals a significant gap between the number of local, pregnant mothers who report smoking during pregnancy and the number who test positive for nicotine exposure.
"This is extremely important new information for us as we work to better understand risk factors for preterm birth," said Jim Greenberg, MD, director of the Perinatal Institute at Cincinnati Children's and senior author of the study. "We have long suspected that smoking during pregnancy is under-reported, but now we know just how many women struggle to quit smoking when they are pregnant."
The study, published online in the Journal of Perinatology, detected high-level nicotine exposure for 16.5 percent of women in the study and low-level exposure for an additional 7.5 percent. Only 8.6 percent, however, admitted to using cigarettes.
Researchers studied 708 women who gave birth at a single maternity hospital in southwest Ohio between March 2014 and August 2015. Birth records in Ohio include those women who self-report last trimester cigarette smoking. But also in southwest Ohio, all maternity centers collect maternal urine samples for drug testing to catch increases in prenatal exposure to opioids. Cotinine is a metabolized byproduct of tobacco exposure measured in urine and in blood. Centers were therefore able to detect nicotine exposure in urine alone.
The study highlighted the importance of public health efforts to decrease tobacco and e-cigarette particularly among pregnant minority women. African American women previously self-reported tobacco use rates of 7.9 percent, but the number rose to 21.1 percent after measurement of cotinine.
Added Dr. Greenberg: "The public health community has long assumed targeted campaigns toward minority women were not needed because we've relied on self-reported data. This new information suggests that approach is profoundly incorrect. New support needs to be offered to a population that's too often ignored when it comes to anti-smoking efforts."
The study also revealed an additional 7.5 percent of women, not minorities, also tested positive for secondhand smoke during pregnancy, bringing total smoke exposure up to nearly one in four women.
Anyone trying to quit smoking during pregnancy can call 1-800-QUIT-NOW to receive personalized support to help them quit during the crucial months of pregnancy — when all systems of a fetus are developing.
Study Design: The study was a retrospective single-center cohort analysis of more than 18 months. We compared self-reported smoking status from vital birth records with mass spectrometry laboratory results of maternal urine using a chi-square test. Logistic regression estimated adjusted odds for detection of drugs of abuse based on nicotine detection.
Results: Compared with 8.6% self-reporting cigarette use, mass spectrometry detected high-level nicotine exposures for 16.5% of 708 women (P<0.001) and an additional 7.5% with low-level exposures. We identified an increased likelihood of exposure to drugs of abuse, presented as adjusted odds ratios, (95% confidence interval (CI), for both low-level (5.69, CI: 2.09 to 15.46) and high-level (13.93, CI: 7.06 to 27.49) nicotine exposures.
Conclusion: Improved measurement tactics are critically needed to capture late pregnancy primary and passive nicotine exposures from all potential sources.
The study was funded by the Amgis Foundation of Medina, NY.
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Maternal urine samples collected to monitor possible opioid use reveal more pregnant women
than expected are being exposed to e-cigarettes, cigarette smoke - or are smoking themselves.
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