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Am J Perinatol 2023; 40(12): 1311-1320
DOI: 10.1055/a-1580-3155
Original Article

Serum Cotinine and Adverse Cardiovascular Outcomes: A Cross-sectional Secondary Analysis of the nuMoM2b Heart Health Study

Lauren H. Theilen
1   Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah
,
Rebecca B. McNeil
2   Division of Biostatistics and Epidemiology, RTI International, Research Triangle Park, North Carolina
,
Shannon Hunter
3   Division of Biostatistics, RTI International, Research Triangle Park, North Carolina
,
William A. Grobman
4   Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
Corette B. Parker
3   Division of Biostatistics, RTI International, Research Triangle Park, North Carolina
,
Janet M. Catov
5   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburg, Pittsburg, Pennsylvania
,
Victoria L. Pemberton
6   Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLB), Bethesda, Maryland
,
Deborah B. Ehrenthal
7   Department of Obstetrics and Gynecology, School of Medicine, University of Wisconsin, Madison, Wisconsin
,
David M. Haas
8   Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana
,
Matthew K. Hoffman
9   Department of Obstetrics and Gynecology, Christiana Care, Wilmington, Delaware
,
Judith H. Chung
10   Department of Obstetrics and Gynecology, School of Medicine, University of California-Irvine, Irvine, California
,
Farhana Mukhtar
10   Department of Obstetrics and Gynecology, School of Medicine, University of California-Irvine, Irvine, California
,
Zorayr Arzumanyan
11   Department of Biomedical Research, The Lundquist Institute, Los Angeles, California
,
Brian Mercer
12   Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, Ohio
,
Samuel Parry
13   Department of Maternal Fetal Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
,
George R. Saade
14   Division Chief of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Hyagriv N. Simhan
15   Department of Obstetrics, Gynecology, and Reproductive Science, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Ronald J. Wapner
16   Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Robert M. Silver
1   Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah
,
for the NHLBI nuMoM2b Heart Health Study Network› Author Affiliations
Funding This work was supported by grants (cooperative agreements) from the National Heart, Lung, and Blood Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U01-HL145358; U10-HL119991; U10-HL119989; U10-HL120034; U10-HL119990; U10-HL120006; U10-HL119992; U10-HL120019; U10-HL119993; and U10-HL120018. Support was also provided by the National Institutes of Health: Office of Disease Prevention; Office of Research on Women's Health; Office of Behavioral and Social Sciences Research; and the National Center for Advancing Translational Sciences – UL-1-TR000124, UL-1-TR000153, UL-1-TR000439, and UL-1-TR001108. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Abstract

Objective We aimed to (1) compare serum cotinine with self-report for ascertaining smoking status among reproductive-aged women; (2) estimate the relative odds of adverse cardiovascular (CV) outcomes among women by smoking status; (3) assess whether the association between adverse pregnancy outcomes (APOs) and CV outcomes varies by smoking status.

Study Design We conducted a cross-sectional study of the nuMoM2b Heart Health Study. Women attended a study visit 2 to 7 years after their first pregnancy. The exposure was smoking status, determined by self-report and by serum cotinine. Outcomes included incident chronic hypertension (HTN), metabolic syndrome (MetS), and dyslipidemia. Multivariable logistic regression estimated odds ratios (ORs) for each outcome by smoking status.

Results Of 4,392 women with serum cotinine measured, 3,610 were categorized as nonsmokers, 62 as secondhand smoke exposure, and 720 as smokers. Of 3,144 women who denied tobacco smoke exposure, serum cotinine was consistent with secondhand smoke exposure in 48 (1.5%) and current smoking in 131 (4.2%) After adjustment for APOs, smoking defined by serum cotinine was associated with MetS (adjusted OR [aOR] = 1.52, 95% confidence interval [CI]: 1.21, 1.91) and dyslipidemia (aOR = 1.28, 95% CI: 1.01, 1.62). When stratified by nicotine exposure, nonsmokers with an APO in their index pregnancy had higher odds of stage 1 (aOR = 1.64, 95% CI: 1.32, 2.03) and stage 2 HTN (aOR = 2.92, 95% CI: 2.17, 3.93), MetS (aOR = 1.76, 95% CI: 1.42, 2.18), and dyslipidemia (aOR = 1.55, 95% CI: 1.25, 1.91) relative to women with no APO. Results were similar when smoking exposure was defined by self-report.

Conclusion Whether determined by serum cotinine or self-report, smoking is associated with subsequent CV outcomes in reproductive-aged women. APOs are also independently associated with CV outcomes in women.

Key Points

  • Cotinine was detected in 5.7% of reported nonsmokers.

  • Smoking and APOs were independently associated with CV health.

  • Smoking was associated with MetS and dyslipidemia.

Keywords

pregnancy - cross-sectional studies - tobacco smoke - nicotine - smokers - pregnancy outcome - cardiovascular diseases


Publication History

Received: 14 May 2021

Accepted: 05 August 2021

Accepted Manuscript online:
06 August 2021

Article published online:
05 October 2021

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