Elsevier

The Journal of Pediatrics

Volume 159, Issue 5, November 2011, Pages 776-782
The Journal of Pediatrics

Original Article
Comparison of Biomarkers and Parent Report of Tobacco Exposure to Predict Wheeze

https://doi.org/10.1016/j.jpeds.2011.04.025Get rights and content

Objective

To identify the optimal measure of active and passive prenatal tobacco exposure to predict wheeze in early life.

Study design

We conducted a birth cohort study of 398 mother-infant dyads enrolled during the second trimester of pregnancy and followed through age 2 years. We measured tobacco exposure with maternal report, serum cotinine level, and meconium cotinine level. We assessed wheeze with parent report every 6 months. We used a repeated measures logistic regression model.

Results

Of 367 children with respiratory data, 26% percent had parent reported active or passive prenatal maternal tobacco exposure, but cotinine was detected in 61% of mothers during pregnancy. Compared with children of mothers in the fifth percentile of tobacco exposure, children of mothers in the 95th percentile had increased odds of wheeze when exposure was measured with maternal serum cotinine level (adjusted OR, 2.6; 95% CI, 1.3-5.2; P < .006) versus meconium cotinine level (adjusted OR, 2.0; 95% CI, 1.0-4.0; P = .04) and total parent-reported exposure (adjusted OR, 1.7; 95% CI, 1.1-2.7; P = .01).

Conclusions

Serum cotinine, a biomarker of tobacco exposure, was more strongly associated with wheeze than parent-reported exposure. Studies that rely on parent report of prenatal tobacco exposure may underestimate risk of wheeze.

Section snippets

Methods

We used data from the Health Outcomes and Measures of the Environment (HOME) Study. The HOME Study is a prospective birth cohort study designed to investigate the effects of prenatal and postnatal exposure to environmental toxicants on the development and behaviors of children. The HOME Study enrolled 468 English-speaking women at 16 (± 2 weeks) gestation who were ≥18 years of age and lived in a home built before 1979. Women were observed through pregnancy, and their children are still being

Results

Participants for whom data were available were more likely to be white, have a mother with more than a high school education, have private insurance, live in non-urban environment, have married parents, have an older mother, have a higher income, have reportedly less prenatal tobacco exposure, and have a lower maternal mean prenatal cotinine level (Table I).

Twelve percent of mothers reported active exposure, and 26% of mothers reported active or passive exposure (Table I). Cotinine was

Discussion

Only 26% of mothers in this cohort reported active or passive tobacco exposure, but >60% of mothers had measurable levels of exposure with serum cotinine. Thus, many pregnant women may not recognize or may underreport tobacco exposure. This exposure can have important health effects for the mother and the fetus. We found that higher levels of prenatal tobacco exposure were associated with increased odds of wheeze in children during the first 2 years after birth; however, the magnitude of this

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    Supported by Flight Attendant Medical Research Foundation Young Clinical Scientist Award and the National Institute of Environmental Health Sciences (1K23ES016304 and PO1ES11261). The authors declare no conflicts of interest.

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