title: Prenatal tobacco exposure and cotinine in newborn dried blood spots.
abstract: BACKGROUND
  Tobacco smoking by pregnant women is a major public health hazard with both short- and long-term effects on offspring. This study describes the presence and level of the nicotine metabolite cotinine in newborn dried blood spots (DBS) and compares it with the reported maternal smoking recorded on state birth registries. We hypothesize that cotinine in DBS may be a useful measure of newborn in utero tobacco exposure.
  
  
  METHODS
  An observational, cross-sectional study of 1414 DBS obtained from California, Michigan, New York, and Washington newborn screening programs was carried out. Cotinine levels in DBS were quantified by liquid chromatography tandem mass spectrometry analysis and compared with maternal smoking as reported in vital statistics data.
  
  
  RESULTS
  Cotinine ≥0.3 ng/g was detected in 35% of newborn DBS, including DBS of 29% of newborns whose mothers reportedly did not smoke cigarettes during pregnancy, some of whom were presumably exposed to environmental tobacco smoke. Twelve percent of the newborn DBS had cotinine levels that were ≥9.0 ng/g (equivalent to 6 ng/mL plasma, a level that indicates active smoking of the mother), although 41% of the mothers of these infants reportedly did not smoke.
  
  
  CONCLUSIONS
  These data confirm that reported smoking during pregnancy is an imperfect measure of prenatal tobacco smoke exposure. Cotinine assessment in newborns may improve surveillance of tobacco use during pregnancy.
authors.affiliation: Departments of Pediatrics,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota spector@umn.edu.
authors.forename: Logan G
authors.initials: LG
authors.lastname: Spector
authors.affiliation: Masonic Cancer Center, University of Minnesota, Minneapolis, MinnesotaBiochemistry, Molecular Biology, and Biophysics, and.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Murphy
authors.affiliation: Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Wickham
authors.affiliation: Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Bruce
authors.initials: B
authors.lastname: Lindgren
authors.affiliation: Masonic Cancer Center, University of Minnesota, Minneapolis, MinnesotaMedicine, University of Minnesota, Minneapolis, Minnesota; and.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Joseph
mesh_terms: D003367:Cotinine / Q000097:blood*; D003430:Cross-Sectional Studies; D059788:Dried Blood Spot Testing; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011247:Pregnancy; D012042:Registries; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D014481:United States
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine
keywords: cotinine; dried blood spot testing; newborn