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Maternal snuff use and cotinine in late pregnancy-A validation study
Anna Gunnerbeck1,2, Pauline Raaschou3, Sven Cnattingius3
1Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Self-reported maternal snuff use during pregnancy is highly accurate, with 98% sensitivity and 96% specificity. However, official birth records misclassify 45% of snuff users, potentially underestimating health risks.
Area of Science:
- Reproductive Health
- Public Health
- Toxicology
Background:
- Oral moist snuff use is prevalent in Sweden, including among pregnant women.
- Maternal snuff use is linked to adverse pregnancy outcomes.
- Previous studies lacked validation for self-reported maternal snuff use.
Purpose of the Study:
- To validate self-reported maternal snuff use during pregnancy.
- To compare self-reported data with biomarker and registry data.
Main Methods:
- Prospective cohort study (2005-2011) of 381 non-smoking pregnant women (263 snuff users).
- Self-reported snuff use via questionnaires and validated with maternal urine cotinine levels.
- Comparison with data from the Swedish Medical Birth Register.
Main Results:
- Maternal urine cotinine confirmed high validity of self-reported snuff use (98% sensitivity, 96% specificity).
- The Medical Birth Register misclassified 45% of late-pregnancy snuff users as non-users.
- Significant variations in cotinine levels observed between pouch types and even among users of similar daily quantities.
Conclusions:
- Self-reported snuff use in pregnancy via questionnaires is a valid measure.
- Medical Birth Register data significantly underestimates snuff use in late pregnancy.
- Underestimation of maternal snuff use in registries risks downplaying associated adverse health effects.
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