[What is appropriate care for women who smoke during pregnancy?]

There are few publications on smoking biomarkers in pregnant woman, but nothing suggests that their contribution differs during pregnancy. Many publications have examined the predictive value of the biomarkers of smoking, but the comparative value is not clear. To our knowledge no study has used biomarkers of the smoking to monitor smoking cessation during pregnancy. Blood nicotine is not retained as a useful biomarker. Most authors retain urinary cotinine as the gold standard. There is no consensus on measurement techniques. Cotinine can be measured in blood, saliva and in cord blood. Active and passive smoking can be monitored with urinary cotinine. Rapid strip tests provide useful results to differentiate smokers from non-smokers, but not to quantify nicotinic intoxication. All published papers have been supported by the firm marketing the strip. There have been few studies in pregnant woman on expired CO rate, but the method is validated. Measurement of thiocyanates and other biomarkers does not currently provide useful information for routine surveillance of pregnant smoking women.