Nicotine and metabolites in meconium as evidence of maternal cigarette smoking during pregnancy and predictors of neonatal growth deficits

Abstract

Introduction: Many women continue tobacco use during pregnancy despite known adverse consequences on neonatal growth and development. Testing meconium, the first neonatal feces, for tobacco biomarkers offers objective evidence of prenatal tobacco exposure. However, relationships between the amount, frequency, and timing of cigarette smoking during gestation and tobacco biomarker meconium concentrations and neonatal outcomes are unclear.Methods: Eighty-seven pregnant women provided detailed self-reports of daily tobacco consumption throughout pregnancy. Nicotine, cotinine, and trans-3-hydroxycotinine were quantified in neonatal meconium by liquid chromatography-tandem mass spectrometry.Results: Among nonsmokers, all meconium specimens were negative, whereas nearly all meconium specimens were positive if the mother self-reported tobacco use into the third trimester. Tobacco biomarker concentrations were significantly albeit weakly correlated with mean cigarettes per day in the third trimester. Reduced birth weight, gestational age, or head circumference were observed if meconium contained one or more tobacco biomarkers, but deficits did not correlate with biomarker concentrations. Conclusion:While previously thought to reflect second and third trimester drug exposure, meconium appears to reliably identify only third trimester drug use. While a 10 ng/g nicotine, cotinine, or trans-3-hydroxycotinine cutoff in meconium was previously proposed to differentiate tobacco-exposed from nonexposed or passively exposed neonates, improved maternal self-reporting techniques in this cohort suggest that a lower cutoff, equivalent to the analytic limits of quantification, is more appropriate.

Sources and Frequency of Secondhand Smoke Exposure During Pregnancy

“…For instance, in a meta-analysis of studies on SHS exposure during pregnancy, Leonardi-Bee, Smyth, Britton, and Coleman (2008) reported a significant association between SHS exposure and low birth weight at term and small for gestational age status among nonsmoking mothers. Other studies have noted similar results with lower fetal biometry at 20-24 weeks gestation (Hanke, Sobala, and Kalinka, 2004), higher risk for fetal death, preterm delivery, and low birth weight (Gray et al, 2010;Jaddoe et al, 2008). SHS exposure during pregnancy has also been associated with poorer respiratory health among infants over the first 6 months of life (Jedrychowski et al, 2007), and among children with asthma, higher exposure to SHS is associated with higher externalizing behavior problems in the early school years (Yolton et al, 2008).…”

Anger, Hostility, and Aggression as Predictors of Persistent Smoking During Pregnancy

“…Previous research indicated that a positive infant meconium sample refl ects primarily third trimester exposure (Gray et al, 2010a(Gray et al, , 2010b. All infants with positive meconium samples had mothers who smoked in at least the fi rst trimester.…”

“…Meconium specimens were assayed with a validated LS-MSMS method for nicotine, cotinine, and trans-3'-hydroxycotinine (Gray et al, 2010a(Gray et al, , 2010b. Among the 189 pregnant smokers, 96% self-reported smoking during pregnancy; 59% had infants with nicotine and/or metabolites in meconium; and 79% had oral fl uid samples that tested positive for cotinine, a primary metabolite of nicotine.…”

Maternal Smoking During Pregnancy and Offspring Brain Structure and Function: Review and Agenda for Future Research

“…Numerous studies (i.e., Gray et al, 2010;Kallen, 2000) that investigated effects of MSDP on fetal and infant head circumference were not included in this review as results have been highly consistent (MSDP associated with decreased fetal and infant head circumference) and because the studies do not provide insight into specific structural or functional alterations of the brain.…”