Lauren H Theilen1, Rebecca B McNeil2, Shannon Hunter3, William A Grobman4, Corette B Parker3, Janet M Catov5, Victoria L Pemberton6, Deborah B Ehrenthal7, David M Haas8, Matthew K Hoffman9, Judith H Chung10, Farhana Mukhtar10, Zorayr Arzumanyan11, Brian Mercer12, Samuel Parry13, George R Saade14, Hyagriv N Simhan15, Ronald J Wapner16, Robert M Silver1. 1. Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah. 2. Division of Biostatistics and Epidemiology, RTI International, Research Triangle Park, North Carolina. 3. Division of Biostatistics, RTI International, Research Triangle Park, North Carolina. 4. Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois. 5. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburg, Pittsburg, Pennsylvania. 6. Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLB), Bethesda, Maryland. 7. Department of Obstetrics and Gynecology, School of Medicine, University of Wisconsin, Madison, Wisconsin. 8. Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana. 9. Department of Obstetrics and Gynecology, Christiana Care, Wilmington, Delaware. 10. Department of Obstetrics and Gynecology, School of Medicine, University of California-Irvine, Irvine, California. 11. Department of Biomedical Research, The Lundquist Institute, Los Angeles, California. 12. Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, Ohio. 13. Department of Maternal Fetal Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 14. Division Chief of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas. 15. Department of Obstetrics, Gynecology, and Reproductive Science, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. 16. Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.
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.. Thieme. All rights reserved.
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.. Thieme. All rights reserved.
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