The association of in utero tobacco smoke exposure, quantified by serum cotinine, and Autism Spectrum Disorder

Abstract

Previous studies on in utero exposure to maternal environmental tobacco smoke (ETS) or maternal active smoking and Autism Spectrum Disorder (ASD) have not been entirely consistent, and no studies have examined in utero cotinine concentrations as an exposure classification method. We measured cotinine in stored second trimester maternal serum for 498 ASD cases and 499 controls born in California in 2011–2012. We also obtained self‐reported maternal cigarette smoking during and immediately prior to pregnancy, as well as covariate data, from birth records. Using unconditional logistic regression, we found no association between log10 cotinine concentrations and odds for developing ASD among children of non‐smokers (aOR: 0.93 [95% CI: 0.69, 1.25] per ng/ml), which represents exposure to ETS, though there may be a possible interaction with race. We found no association between cotinine‐defined smoking (≥3.08 ng/ml vs. <3.08 ng/ml) (adjusted odds ratio [aOR]: 0.73 (95% confidence interval [95% CI]: 0.35, 1.54)) or self‐reported smoking (aOR: 1.64 [95% CI: 0.65, 4.16]) and ASD. In one of the few studies of ETS and the first with measured cotinine, our results indicate no overall relationship between in utero exposure to tobacco smoke from maternal ETS exposure or active smoking, and development of ASD. Lay Summary This study found that women who smoke or are exposed to tobacco smoke during pregnancy are not more likely to have children with Autism Spectrum Disorder (ASD). This is the first ASD study to measure a chemical in the mother's blood during pregnancy to identify exposure to tobacco smoke.

Socio-economic status and autism spectrum disorder: A case-control study in Bangladesh

“…Notably, the education level for most of the Bangladeshi fathers ( Afrin et al, 2021 ) and Omani mothers ( Al-Mamari et al, 2021 ) having a child with autism was a bachelor degree or above. While certain studies ( Hamra et al, 2019 , von Ehrenstein et al, 2019 , Berger et al, 2021 ) have supported a positive association of advanced maternal education with ASD odds, others ( Soke et al, 2019 , Afrin et al, 2021 ) have found negative trends.…”

“…For the questionnaire, SES and related SDFs were logically chosen as independent variables (IVs). The structured questionnaire was constructed after an extensive review of existing literatures ( Pham et al, 2022 , Khan et al, 2022 , Berger et al, 2021 , Al-Mamari et al, 2021 , Afrin et al, 2021 , Acharya and Sharma, 2021 , Hegazy et al, 2021 , Alali et al, 2021 , Carlsson et al, 2021 , Luo et al, 2020 , Roy et al, 2020 , Volk et al, 2020 , Begum et al, 2020 , Xie et al, 2020 , von Ehrenstein et al, 2019 , Fatema et al, 2019 , Hamra et al, 2019 , Maia et al, 2019 , Soke et al, 2019 , Bhuiyan et al, 2017 ) and focused on Bangladeshi SES and related SDFs ( Table 3 ) that might be associated with the odds of ASD in Bangladesh. The questionnaire was validated by experts from academics (supervisor, biostatistician), practitioners (paediatrician, physician, disability specialists) and a researcher specializing in autism, guided by the existing literature ( Elangovan & Sundaravel, 2021 ).…”

A biomarker‐based study of prenatal smoking exposure and autism in a Finnish national birth cohort

“…That our study arrived at similar results instead using prenatal maternal cotinine as a biomarker of nicotine exposure supports the findings of these prior studies based on a measure with reduced exposure misclassification. A recent California study that examined prenatal cotinine levels in a population with low smoking prevalence (<4%) did not find evidence that these levels were associated with offspring autism (Berger et al, 2021). This comports with our findings of no association between maternal cotinine levels and offspring autism within the range of levels consistent with ETS exposure.…”

Prenatal nicotine exposure during pregnancy results in adverse neurodevelopmental alterations and neurobehavioral deficits

“…To account for the bias associated with self-reports of PNE, another study measured cotinine in stored second trimester maternal serum for 499 controls and 498 ASD cases born in California between 2011 and 2012 [ 120 ]. In addition to measuring cotinine levels, the researchers also obtained self-reported maternal cigarette smoking information during and immediately prior to pregnancy and covariate data from birth records.…”

“…The results of their study found no association between cotinine concentrations and odds for developing ASD among children of non-smokers (aOR: 0.93 [95% CI: 0.69, 1.25] per ng/mL). Moreover, they found no associated between self-reported smoking (aOR:1.64 [95% CI: 0.65, 4.16]) or cotinine-defined smoking ( 3.08 ng/mL vs. < 3.08 ng/mL; aOR: 0.73 [95% CI: 0.35, 1.54]) and ASD [ 120 ].…”