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Regional comparison of self-reported late pregnancy cigarette smoking to mass spectrometry analysis



To report a more accurate prevalence estimate of late pregnancy nicotine exposures.

Study design

A cross-sectional study during a 2-month period in 2019. Participants were women delivering in any of the six county maternity hospitals who consented to universal drug testing at the time of delivery as part of routine hospital admission.


Of 2531 tested samples, 18.7% tested positive for high levels of cotinine indicating primary smoking or other primary use of tobacco products. Together, 33.0% of the study population tested positive for nicotine exposure during late pregnancy compared to vital records which reported 8.2% cigarette smoking during the third trimester of pregnancy and 10.5% cigarette smoking at any time during pregnancy through maternal self-report.


Captured vital birth smoking measures vastly underreport actual primary exposures to nicotine products. Vital birth data also fail to capture secondhand exposures which constitute a significant proportion of the population.

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Fig. 1: Distribution of study cohort mass spectrometry levels (ng/ml) among results testing positive for any level of cotinine.


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This study includes data provided by the Ohio Department of Health, which should not be considered an endorsement of the study or its conclusions. This work was supported by a grant from Chiesi Farmaceutici and by a gift from Amgis Foundation Inc. Although both organizations provided financial support, neither participated in study design, data collection, data analysis and interpretation, or manuscript preparation.

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Correspondence to Scott L. Wexelblatt.

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Conflict of interest

SLW and ESH have been consultants for Braeburn Pharmaceuticals. SLW is on the Abbott Nutrition speaker’s bureau. All other authors have no competing interests.

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Hall, E.S., McAllister, J.M., Kelly, E.A. et al. Regional comparison of self-reported late pregnancy cigarette smoking to mass spectrometry analysis. J Perinatol (2021).

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