Abstract
BackgroundResearch has shown that self-reports of smoking during pregnancy may underestimate true prevalence. However, little is known about which populations have higher rates of underreporting. Availability of more accurate measures of smoking during pregnancy could greatly enhance the usefulness of existing studies on the effects of maternal smoking offspring, especially in those populations where underreporting may lead to underestimation of the impact of smoking during pregnancy.Methods and FindingsIn this paper, we develop a statistical Monte Carlo model to estimate patterns of underreporting of smoking during pregnancy, and apply it to analyze the smoking self-report data from birth certificates in the state of Massachusetts. Our results illustrate non-uniform patterns of underreporting of smoking during pregnancy among different populations. Estimates of likely underreporting of smoking during pregnancy were highest among mothers who were college-educated, married, aged 30 years or older, employed full-time, and planning to breastfeed. The model's findings are validated and compared to an existing underreporting adjustment approach in the Maternal and Infant Smoking Study of East Boston (MISSEB).ConclusionsThe validation results show that when biological assays are not available, the Monte Carlo method proposed can provide a more accurate estimate of the smoking status during pregnancy than self-reports alone. Such methods hold promise for providing a better assessment of the impact of smoking during pregnancy.
Highlights
In a 2001 report, the Surgeon General of the United States described decades of research into the specific health effects of cigarette smoking on women [1]
The validation results show that when biological assays are not available, the Monte Carlo method proposed can provide a more accurate estimate of the smoking status during pregnancy than self-reports alone
The report catalogues a long list of pregnancy complications and adverse birth outcomes associated with smoking during pregnancy but perhaps the most thoroughly documented is that of low birth weight [2,3,4,5]
Summary
In a 2001 report, the Surgeon General of the United States described decades of research into the specific health effects of cigarette smoking on women [1]. There is no single level of cotinine or nicotine that can be uniquely associated with a specific number of cigarettes smoked. Further complicating this picture is evidence that the metabolism of nicotine and cotinine is accelerated during pregnancy [6,7,8]. The adjustment methodology proposed by Dukic requires cotinine measures and is impractical for large population studies. Availability of more accurate measures of smoking during pregnancy could greatly enhance the usefulness of existing studies on the effects of maternal smoking offspring, especially in those populations where underreporting may lead to underestimation of the impact of smoking during pregnancy
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