title: Smoking in Pregnancy and Fetal Growth: The Case for More Intensive Assessment.
abstract: BACKGROUND
  Many studies on prenatal tobacco exposure (PTE) effects have relied on single item retrospective measures of PTE. However, it is unclear how these single item measures may relate to more intensive maternal self-reports and to biological markers of maternal use and/or fetal exposure. It is also unclear whether these measures may be more valid predictors of fetal growth (gestational age, birthweight, head circumference, and birth length).
  
  
  METHODS
  Data were obtained from 258 women during their pregnancy. PTE was assessed by four methods: a single item question, a calendar-based self-report measure from each trimester of pregnancy, maternal salivary cotinine assays, and nicotine and metabolites in infant meconium. We hypothesized that the more intensive measures and biological assays would account for additional variance in birth outcomes, above and beyond the single item measure.
  
  
  RESULTS
  The single item self-report measure was not related to fetal growth. However, the more intensive calendar based self-report measure and the biological assays of PTE (ie, maternal salivary assays and infant meconium) were significant predictors of poor fetal growth, even with the single item measure in the model.
  
  
  CONCLUSIONS
  The negative effects of PTE on important child outcomes may be greatly underestimated in the literature as many studies use single item self-report measures to ascertain PTE. Whereas more intensive self-report measures or biological assays may be cost prohibitive in large scale epidemiological studies, using a combination of measures when possible should be considered given their superiority both identifying prenatal smokers and predicting poor fetal growth.
  
  
  CONCLUSIONS
  The present work underscores the importance of measurement issues when assessing associations between PTE and fetal growth. Results suggest that we may be greatly underestimating the negative effects of prenatal smoking on fetal growth and other important child outcomes if we rely solely on restricted single item self-report measures of prenatal smoking. Researchers should consider more intensive prospective self-report measures and biological assays as viable and superior alternatives to single item self-report measures.
authors.affiliation: Research Institute on Addictions, State University of New York at Buffalo, Buffalo, NY.
authors.forename: Shannon
authors.initials: S
authors.lastname: Shisler
authors.affiliation: Research Institute on Addictions, State University of New York at Buffalo, Buffalo, NY.
authors.forename: Rina D
authors.initials: RD
authors.lastname: Eiden
authors.affiliation: Research Institute on Addictions, State University of New York at Buffalo, Buffalo, NY.|Department of Child and Youth Studies, Brock University, St. Catharines, Canada.
authors.forename: Danielle S
authors.initials: DS
authors.lastname: Molnar
authors.affiliation: Department of Psychology, SUNY Buffalo State, Buffalo, NY.
authors.forename: Pamela
authors.initials: P
authors.lastname: Schuetze
authors.affiliation: University of Maryland Baltimore School of Medicine, Baltimore, MD.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Huestis
authors.affiliation: Department of Community Health and Health Behavior, State University of New York at Buffalo, Buffalo, NY.
authors.forename: Gregory
authors.initials: G
authors.lastname: Homish
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D001724:Birth Weight / Q000187:drug effects*; D003367:Cotinine / Q000009:adverse effects / Q000032:analysis / Q000378:metabolism; D005260:Female; D047109:Fetal Development / Q000187:drug effects*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008431:Maternal-Fetal Exchange / Q000187:drug effects; D008470:Meconium / Q000378:metabolism; D009538:Nicotine / Q000009:adverse effects / Q000032:analysis / Q000378:metabolism; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology; D012463:Saliva / Q000378:metabolism; D057566:Self Report; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology / Q000378:metabolism; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D009538:Nicotine; D003367:Cotinine