• environmental tobacco smoke;
  • maternal report;
  • cotinine validation;
  • maternal urine;
  • cord blood


Baheiraei A, Banihosseini SZ, Heshmat R, Mota A, Mohsenifar A. Association of self-reported passive smoking in pregnant women with cotinine level of maternal urine and umbilical cord blood at delivery. Paediatric and Perinatal Epidemiology 2012; 26: 70–76.

Passive smoking during pregnancy leads to adverse effects on mother and infant. The present investigation was designed to evaluate the association between maternal reported passive smoking with the cotinine concentration of maternal urine and umbilical cord blood at delivery and to determine the accuracy of maternal reporting of exposure to cigarette smoke during pregnancy. This was a cross-sectional study. From the 108 non-smoker pregnant women who were referred for delivery, 54 were passive smokers. Urine samples were collected from the mothers in the delivery room and blood samples after birth were taken from the umbilical cord. Passive smoking was evaluated through questionnaire and cotinine level of urine and umbilical cord blood. The geometric mean cotinine concentration of the maternal urine and the umbilical cord serum were, respectively, 27.4 ± 29.96 ng/mL and 3.71 ± 1.22 ng/mL in the exposed group (P < 0.001) and 0.75 ± 2.29 and 0.40 ± 0.63 in the non-exposed group (P < 0.001). There was a statistically significant correlation between maternal urinary and umbilical cord serum level of cotinine (P < 0.001, r = 0.58). Significant associations were shown between maternal reports of exposure to cigarette smoking with cotinine level of urine (kappa = 96%) and umbilical cord (kappa = 98%) (P < 0.001). This study shows that the pregnant woman's report of passive smoking during pregnancy in Iran is accurate. The questionnaire is an appropriate method to evaluate smoke exposure and could replace cotinine measurement.