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

Lauren H. Theilen, Rebecca B. McNeil, Shannon Hunter, William A. Grobman, Corette B. Parker, Janet M. Catov, Victoria L. Pemberton, Deborah B. Ehrenthal, David M. Haas, Matthew K. Hoffman, Judith H. Chung, Farhana Mukhtar, Zorayr Arzumanyan, Brian Mercer, Samuel Parry, George R. Saade, Hyagriv N. Simhan, Ronald J. Wapner, Robert M. Silver

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)1311-1320
Number of pages10
JournalAmerican Journal of Perinatology
Issue number12
StatePublished - Oct 5 2021


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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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