title: Antenatal and early life tobacco smoke exposure in an African birth cohort study.
abstract: Exposure to tobacco smoke in African infants has not been well studied, despite the high burden of childhood respiratory disease in these communities.
  
  
  
  To investigate the prevalence of antenatal and early life tobacco smoke exposure and associations with infant birth outcomes in an African birth cohort, the Drakenstein Child Health Study.
  
  
  
  Self-report questionnaires assessing maternal and household smoking were administered. Maternal and infant urine cotinine testing was conducted antenatally, at birth and at 6-10 weeks of life to measure tobacco smoke exposure. Multivariate regression models explored the associations between exposure to smoke and infant birth outcomes.
  
  
  
  Of 789 pregnant women included, 250 (32%) were active smokers on cotinine testing. At birth and at 6-10 weeks of life, respectively 135/241 (56%) and 154/291 (53%) infants had urine cotinine levels indicating tobacco smoke exposure. Household smoking was prevalent and was associated with positive infant cotinine test results. Antenatal maternal smoking was associated with decreased infant birthweight-for-age Z-score (0.3, 95%CI 0.1-0.5).
  
  
  
  Antenatal and early life tobacco smoke exposure is highly prevalent in this community, and may impact on birth outcomes and subsequent child health. Smoking cessation interventions are urgently needed to reduce tobacco smoke exposure in African communities.
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and Medical Research Council (MRC) Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa.
authors.forename: A
authors.initials: A
authors.lastname: Vanker
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and Medical Research Council (MRC) Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa.
authors.forename: W
authors.initials: W
authors.lastname: Barnett
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and Medical Research Council (MRC) Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa.
authors.forename: K
authors.initials: K
authors.lastname: Brittain
authors.affiliation: Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Stellenbosch University, Cape Town, South Africa.
authors.forename: R P
authors.initials: RP
authors.lastname: Gie
authors.affiliation: Department of Psychiatry and Mental Health and MRC Unit on Anxiety & Stress Disorders, University of Cape Town, Cape Town, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Koen
authors.affiliation: Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council and Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
authors.forename: B
authors.initials: B
authors.lastname: Myers
authors.affiliation: Department of Psychiatry and Mental Health and MRC Unit on Anxiety & Stress Disorders, University of Cape Town, Cape Town, South Africa.
authors.forename: D J
authors.initials: DJ
authors.lastname: Stein
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and Medical Research Council (MRC) Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa.
authors.forename: H J
authors.initials: HJ
authors.lastname: Zar
mesh_terms: D015331:Cohort Studies; D003367:Cotinine / Q000652:urine; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D049590:Postpartum Period; D011247:Pregnancy; D011256:Pregnancy Outcome; D015995:Prevalence; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000453:epidemiology* / Q000209:etiology; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology*; D011795:Surveys and Questionnaires
chemical_list: D003367:Cotinine