Epidemiology Research Unit - Institute of Public Health, University of Porto

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Urinary cotinine assessment of maternal smoking and environmental tobacco smoke exposure status and its associations with perinatal outcomes: a cross-sectional birth study

Publication . Silva, Ana Inês; Camelo, Alexandra; Madureira, Joana; Reis, Ana Teresa; Machado, Ana Paula; Teixeira, João Paulo; Costa, Carla

Abstract: Tobacco consumption and environmental tobacco smoke (ETS) exposure remains an important public health concern. Pregnant women require particular attention as active and passive smoking during pregnancy are associated with multiple adverse perinatal outcomes. This study aimed to biochemically validate self-reported smoking and ETS exposure status among pregnant women, to more precisely ascertain its association with adverse perinatal outcomes. Data refers to 595 pregnant women who sought prenatal care in a public hospital in Porto, Portugal. A standard questionnaire on smoking and ETS-related variables was completed. Urinary cotinine (UC) concentrations were assessed by solid-phase competitive ELISA, in maternal urine samples collected on the day of delivery. The results showed that the optimal UC cut-off value to distinguish smokers from non-smokers and within non-smokers those who were exposed to ETS from those non-exposed in the third trimester of pregnancy was 74.1 ng/mL (sensitivity and specificity of 96.7% and 98.0%, respectively) and 1.6 ng/mL (sensitivity of 66.2% and specificity of 75.7%, respectively). The agreement between maternal self-reported and UC-based smoking status was very good (κ=0.919, p<0.001), but much lower for ETS exposure (κ=0.386, p<0.001). Maternal active smoking in the third trimester of pregnancy was associated with a significant decrease in birth weight, length and head circumference of 157.66 g (95% CI: −245.81, −69.52; p<0.001), 0.78 cm (95% CI: −1.22, −0.34; p=0.001) and 0.39 cm (95% CI: −0.70, −0.07; p=0.016), respectively. Maternal ETS exposure in the third trimester of pregnancy was associated with a non-significant increase in birth weight of 38.37 g (95% CI: −28.91, 105.64; p=0.263). Furthermore, maternal smoking cessation was associated with the increase of approximately 172 g in birth weight (95% CI: 50.00, 293.19). As such, there is an urgent need for increased public health awareness campaigns to encourage smoking cessation during pregnancy, in order to improve perinatal outcomes.

2022-01Journal article

Restricted access

The importance of socioeconomic position in smoking, cessation and environmental tobacco smoke exposure during pregnancy

Publication . Madureira, Joana; Camelo, Alexandra; Silva, Ana Inês; Reis, Ana Teresa; Esteves, Filipa; Ribeiro, Ana Isabel; Teixeira, João Paulo; Costa, Carla

Tobacco is still a leading cause of premature death and morbidity. Particular attention has been given to pregnant women due to the scientific evidence on the importance of early life exposures for disease onset later in life. The purpose of this study was to assess smoking prevalence, smoking cessation rate and environmental tobacco smoke (ETS) exposure, and the role of socioeconomic position (SEP) on these behaviors among pregnant women. Cross-sectional data of 619 pregnant women, aged between 18 and 46 years, from Porto Metropolitan Area, Portugal, on current smoking, ETS exposure and SEP indicators was collected, face-to-face, using a questionnaire filled in during a personal interview at the postpartum hospital stay. The smoking prevalence, and ETS exposure among non-smokers before pregnancy was 27.6% and 57.4%, respectively. 4.1% of the participants reported to have stopped smoking before pregnancy, whereas about 41% quitted along pregnancy, resulting in a smoking prevalence at birth of 14.6%. Exposure to ETS also decreased throughout pregnancy to 49.8% at birth. Lower educational level was significantly associated with both higher smoking prevalence and exposure to ETS and lower smoking cessation. This study demonstrates that smoking and ETS exposure during pregnancy remains high, and that there are still significant socioeconomic inequalities in smoking; thus tobacco-focused preventive interventions need to be reinforced.

2020-09-24Journal article

Open access

Caracterização da exposição ao tabaco durante a gravidez e da sua influência em indicadores de saúde neonatal: projeto NeoGene

Publication . Madureira, Joana; Silva, Ana Inês; Camelo, Alexandra; Reis, Ana Teresa; Machado, Ana Paula; Ribeiro, Ana Isabel; Teixeira, João Paulo; Costa, Carla

O tabagismo e a exposição ao fumo ambiental do tabaco (ou exposição passiva) estão associados a vários efeitos adversos na saúde, particularmente em períodos de maior suscetibilidade como o período pré-natal. Como condição essencial para o delineamento de estratégias mais adequadas e efetivas de promoção de saúde e prevenção de doença associadas, torna-se essencial caracterizar detalhadamente a exposição ao tabaco no início da vida e conhecer a sua influência em diferentes indicadores de saúde neonatal. Para tal, foi analisada informação individual e clínica de 595 grávidas com mais de 36 semanas de gestação, em consulta no Serviço de Obstetrícia e Ginecologia do Centro Hospitalar de S. João, entre abril de 2017 e julho de 2018. Foram também analisados indicadores de saúde neonatais dos respetivos recém-nascidos por consulta dos seus processos clínicos. Os resultados deste estudo mostram uma prevalência do consumo do tabaco de 27,9% antes da gravidez, valor que diminui para 12,9% ao nascimento, como resultado de uma cessação tabágica de 46,4% durante a gestação. Em termos de exposição passiva ao fumo do tabaco, verificou-se que 31,7% das participantes não fumadoras estavam diariamente expostas, durante mais de uma hora, antes da gravidez, e que houve uma diminuição da exposição ao longo da gravidez (26,3% no terceiro trimestre). A análise da associação entre os indicadores de saúde neonatal e os comportamentos tabágicos apontam para uma diminuição do peso, tamanho e perímetro cefálico ao nascimento entre os recém-nascidos das participantes fumadoras, valores que aumentam nos casos em que há cessação tabágica durante a gravidez

2022-05Journal article

Open access