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

doi:10.1055/a-1580-3155

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

^*Corresponding author for this work

Obstetrics and Gynecology

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

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 language	English (US)
Pages (from-to)	1311-1320
Number of pages	10
Journal	American journal of perinatology
Volume	40
Issue number	12
DOIs	https://doi.org/10.1055/a-1580-3155
State	Published - Oct 5 2021

Funding

H.N.S. reports grants from National Institutes of Health during the conduct of the study. B.M. reports grants from National Institutes of Health during the conduct of the study. M.K.H. reports grants from National Institute of Child Health and Human Development during the conduct of the study. C.B.P. reports grants from National Institutes of Health/National Heart, Lung, and Blood Institute during the conduct of the study. S.H. reports grants from National Heart, Lung, and Blood Institute, grants from Eunice Kennedy Shriver National Institute of Child Health and Human Development during the conduct of the study. R.B.M. reports grants from National Institutes of Health/National Heart, Lung, and Blood Institute during the conduct of the study. L.H.T. reports grants from American Association of Obstetricians and Gynecologists Foundation Scholar Award, from null, outside the submitted work. This work was supported by grants (cooperative agreements) from the National Heart, Lung, and Blood Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U01-HL145358; U10-HL119991; U10-HL119989; U10-HL120034; U10-HL119990; U10-HL120006; U10-HL119992; U10-HL120019; U10-HL119993; and U10-HL120018. Support was also provided by the National Institutes of Health: Office of Disease Prevention; Office of Research on Women’s Health; Office of Behavioral and Social Sciences Research; and the National Center for Advancing Translational Sciences – UL-1-TR000124, UL-1-TR000153, UL-1-TR000439, and UL-1-TR001108. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords

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

ASJC Scopus subject areas

Obstetrics and Gynecology
Pediatrics, Perinatology, and Child Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1055/a-1580-3155

Cite this

Theilen, L. H., McNeil, R. B., Hunter, S., Grobman, W. A., Parker, C. B., Catov, J. M., Pemberton, V. L., Ehrenthal, D. B., Haas, D. M., Hoffman, M. K., Chung, J. H., Mukhtar, F., Arzumanyan, Z., Mercer, B., Parry, S., Saade, G. R., Simhan, H. N., Wapner, R. J., & Silver, R. M. (2021). Serum Cotinine and Adverse Cardiovascular Outcomes: A Cross-sectional Secondary Analysis of the nuMoM2b Heart Health Study. American journal of perinatology, 40(12), 1311-1320. https://doi.org/10.1055/a-1580-3155

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

abstract = "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.",

keywords = "cardiovascular diseases, cross-sectional studies, nicotine, pregnancy, pregnancy outcome, smokers, tobacco smoke",

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

note = "Funding Information: H.N.S. reports grants from National Institutes of Health during the conduct of the study. B.M. reports grants from National Institutes of Health during the conduct of the study. M.K.H. reports grants from National Institute of Child Health and Human Development during the conduct of the study. C.B.P. reports grants from National Institutes of Health/National Heart, Lung, and Blood Institute during the conduct of the study. S.H. reports grants from National Heart, Lung, and Blood Institute, grants from Eunice Kennedy Shriver National Institute of Child Health and Human Development during the conduct of the study. R.B.M. reports grants from National Institutes of Health/National Heart, Lung, and Blood Institute during the conduct of the study. L.H.T. reports grants from American Association of Obstetricians and Gynecologists Foundation Scholar Award, from null, outside the submitted work. Funding Information: This work was supported by grants (cooperative agreements) from the National Heart, Lung, and Blood Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U01-HL145358; U10-HL119991; U10-HL119989; U10-HL120034; U10-HL119990; U10-HL120006; U10-HL119992; U10-HL120019; U10-HL119993; and U10-HL120018. Support was also provided by the National Institutes of Health: Office of Disease Prevention; Office of Research on Women{\textquoteright}s Health; Office of Behavioral and Social Sciences Research; and the National Center for Advancing Translational Sciences – UL-1-TR000124, UL-1-TR000153, UL-1-TR000439, and UL-1-TR001108. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} 2021 Thieme Medical Publishers, Inc.. All rights reserved.",

year = "2021",

month = oct,

day = "5",

doi = "10.1055/a-1580-3155",

language = "English (US)",

volume = "40",

pages = "1311--1320",

journal = "American journal of perinatology",

issn = "0735-1631",

publisher = "Thieme Medical Publishers, Inc.",

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}

Theilen, LH, McNeil, RB, Hunter, S, Grobman, WA, Parker, CB, Catov, JM, Pemberton, VL, Ehrenthal, DB, Haas, DM, Hoffman, MK, Chung, JH, Mukhtar, F, Arzumanyan, Z, Mercer, B, Parry, S, Saade, GR, Simhan, HN, Wapner, RJ & Silver, RM 2021, 'Serum Cotinine and Adverse Cardiovascular Outcomes: A Cross-sectional Secondary Analysis of the nuMoM2b Heart Health Study', American journal of perinatology, vol. 40, no. 12, pp. 1311-1320. https://doi.org/10.1055/a-1580-3155

TY - JOUR

T1 - Serum Cotinine and Adverse Cardiovascular Outcomes

T2 - A Cross-sectional Secondary Analysis of the nuMoM2b Heart Health Study

AU - Theilen, Lauren H.

AU - McNeil, Rebecca B.

AU - Hunter, Shannon

AU - Grobman, William A.

AU - Parker, Corette B.

AU - Catov, Janet M.

AU - Pemberton, Victoria L.

AU - Ehrenthal, Deborah B.

AU - Haas, David M.

AU - Hoffman, Matthew K.

AU - Chung, Judith H.

AU - Mukhtar, Farhana

AU - Arzumanyan, Zorayr

AU - Mercer, Brian

AU - Parry, Samuel

AU - Saade, George R.

AU - Simhan, Hyagriv N.

AU - Wapner, Ronald J.

AU - Silver, Robert M.

N1 - Funding Information: H.N.S. reports grants from National Institutes of Health during the conduct of the study. B.M. reports grants from National Institutes of Health during the conduct of the study. M.K.H. reports grants from National Institute of Child Health and Human Development during the conduct of the study. C.B.P. reports grants from National Institutes of Health/National Heart, Lung, and Blood Institute during the conduct of the study. S.H. reports grants from National Heart, Lung, and Blood Institute, grants from Eunice Kennedy Shriver National Institute of Child Health and Human Development during the conduct of the study. R.B.M. reports grants from National Institutes of Health/National Heart, Lung, and Blood Institute during the conduct of the study. L.H.T. reports grants from American Association of Obstetricians and Gynecologists Foundation Scholar Award, from null, outside the submitted work. Funding Information: This work was supported by grants (cooperative agreements) from the National Heart, Lung, and Blood Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U01-HL145358; U10-HL119991; U10-HL119989; U10-HL120034; U10-HL119990; U10-HL120006; U10-HL119992; U10-HL120019; U10-HL119993; and U10-HL120018. Support was also provided by the National Institutes of Health: Office of Disease Prevention; Office of Research on Women’s Health; Office of Behavioral and Social Sciences Research; and the National Center for Advancing Translational Sciences – UL-1-TR000124, UL-1-TR000153, UL-1-TR000439, and UL-1-TR001108. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: © 2021 Thieme Medical Publishers, Inc.. All rights reserved.

PY - 2021/10/5

Y1 - 2021/10/5

N2 - 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.

AB - 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.

KW - cardiovascular diseases

KW - cross-sectional studies

KW - nicotine

KW - pregnancy

KW - pregnancy outcome

KW - smokers

KW - tobacco smoke

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UR - http://www.scopus.com/inward/citedby.url?scp=85116916916&partnerID=8YFLogxK

U2 - 10.1055/a-1580-3155

DO - 10.1055/a-1580-3155

M3 - Article

C2 - 34359079

AN - SCOPUS:85116916916

SN - 0735-1631

VL - 40

SP - 1311

EP - 1320

JO - American journal of perinatology

JF - American journal of perinatology

IS - 12

ER -

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

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