scholarly journals The Influence of Various Smoking Categories on The Risk of Gestational Hypertension and Pre-Eclampsia

2020 ◽  
Vol 9 (6) ◽  
pp. 1743 ◽  
Author(s):  
Małgorzata Lewandowska ◽  
Barbara Więckowska
Keyword(s):  
Odds Ratio ◽  
Gestational Hypertension ◽  
First Trimester ◽  
Multivariate Logistic Regression ◽  
Smoking During Pregnancy ◽  
Quit Smoking ◽  
Induced Hypertension ◽  
Quitting Smoking ◽  
The Relationship ◽  
Lower Odds Ratio

The relationship between smoking and the risk of pregnancy-induced hypertension (PIH) is not clearly established. Therefore, we conducted an analysis of cigarette smoking in a Polish cohort of women, recruited in the first trimester of a single pregnancy in 2015–2016. We evaluated the women who subsequently developed PIH (n = 137) (gestational hypertension—GH (n = 113) and pre-eclampsia—PE (n = 24)), and the women who remained normotensive (n = 775). The diseases odds ratios (and 95% CI—confidence intervals) were calculated in a multivariate logistic regression. In the PIH cases (vs. normotensive women) we found more smokers (25.6% vs. 17.2%, p = 0.020) including smokers in the first trimester (14.6% vs. 4.8%, p < 0.001). The average number of cigarettes smoked daily per smokers in the first trimester was 11.2 (range 2–30), and the average number of years of smoking was 11.6 (range 2–25). The number of years of smoking was a stronger risk factor for GH and PE than the number of cigarettes/day. Compared to the women who have never smoked, smoking ever before pregnancy was associated with a higher GH risk (AOR = 1.68; p = 0.043), and with no effect on PE risk (OR = 0.97; p = 0.950). Smokers in the first trimester had a higher odds ratio of GH (AOR = 4.75; p < 0.001) and PE (OR = 2.60; p = 0.136). Quitting smoking before pregnancy (ex-smokers) was associated with a lower odds ratio of GH (AOR = 0.83; p = 0.596) and PE (OR = 0.33; p = 0.288). However, quitting smoking during pregnancy was associated with a higher risk of GH (AOR = 11.63; p < 0.0001) and PE (OR = 3.57; p = 0.238). After dissection of the cohort into pre-pregnancy body–mass index (BMI) categories, smoking in the first trimester was associated with the higher hypertension risk in underweight women (OR = 22.00, p = 0.024). Conclusions: The factors that increased the risk of GH and PE were smoking in the first trimester and (paradoxically and more strongly) smoking cessation during pregnancy. Our results suggest that women of childbearing potential should be encouraged to quit smoking before pregnancy.

scholarly journals 3547 Relationship between smoking and alcohol use status: variations in candidate genes associated with addiction and successful quitting smoking

2019 ◽  
Vol 3 (s1) ◽  
pp. 52-52
Author(s):  
Magda Shaheen ◽  
Amira Brown ◽  
Deyu Pan ◽  
Katrina Schrode
Keyword(s):  
Alcohol Use ◽  
Genetic Variants ◽  
Odds Ratio ◽  
Genetic Data ◽  
Nhanes Iii ◽  
Multivariate Logistic Regression ◽  
Quit Smoking ◽  
Heavy Drinkers ◽  
Quitting Smoking ◽  
Study Population

OBJECTIVES/SPECIFIC AIMS: Previous studies showed that 52% of smokers were unsuccessful in quitting smoking. Smoking in alcoholics is 2-3 times that of the general population with 50%-80% of alcoholics smoking regularly. Studies have linked several genetic variants to addiction. We examined the relation between successful quitting smoking, alcohol use, and genetic data for CYP2A6, CYP2B6, DRD2, DRD1 and GABRB1 alleles. METHODS/STUDY POPULATION: We analyzed data from NHANES III 1988-1994 for socioeconomic factors, physical activity, body mass index (BMI), alcohol status, successful quit smoking, and genetic data for CYP2A6, CYP2B6, DRD2, DRD1 and GABRB1 alleles. Multivariate logistic regression was used to examine the association between successful quit smoking and genotypes adjusting for other variables. Data were analyzed using SAS version 9.3 (design & weight). RESULTS/ANTICIPATED RESULTS: Of the 2,269 smokers, 57% were current smokers, 35% were heavy drinkers, 24% were both smokers & heavy drinkers and 41% successfully quitted smoking. Successfully quit smoking was associated with CYP2A6 (rs28399433-TG) (adjusted odds ratio (AOR) = 3.6, 95% confidence interval (CI) = 1.1-11.9, p = 0.03), CYP2B6 (rs2279343-AA and AG) (AOR = 2.3, 95%CI = 1.5-3.5, p = 0.0003 for AA & AOR = 2.3, 95%CI = 1.2-4.2, p = 0.01 for AG) and DRD1 (rs4532-AA) (AOR = 2.2, 95%CI = 1.01-4.6, p = 0.04). Among heavy drinkers, those with CYP2A6 (rs28399433-TG) and CYP2B6 (rs2279343-AA and AG) were more likely to successfully quit smoking and those with CYP2A6 (rs5031017-GG) and GABRB1 (rs1442099-CC) were less likely to successfully quit smoking (p<0.05). DISCUSSION/SIGNIFICANCE OF IMPACT: We concluded that while rs28399433-TG, rs2279343-AA & AG positively impacted the success to quit smoking, rs5031017-GG & rs1442099-CC negatively impacted the success in quitting smoking both overall and specifically in heavy drinker smokers.

scholarly journals The Association of Familial Hypertension and Risk of Gestational Hypertension and Preeclampsia

2021 ◽  
Vol 18 (13) ◽  
pp. 7045
Author(s):  
Małgorzata Lewandowska
Keyword(s):  
Risk Factor ◽  
Pregnant Women ◽  
Odds Ratio ◽  
Independent Risk Factor ◽  
Gestational Hypertension ◽  
First Trimester ◽  
Chronic Hypertension ◽  
Modifiable Factors ◽  
The Family ◽  
Maternal Hypertension

It has not been established how history of hypertension in the father or mother of pregnant women, combined with obesity or smoking, affects the risk of main forms of pregnancy-induced hypertension. A cohort of 912 pregnant women, recruited in the first trimester, was assessed; 113 (12.4%) women developed gestational hypertension (GH), 24 (2.6%) developed preeclampsia (PE) and 775 women remained normotensive (a control group). Multiple logistic regression was used to calculate adjusted odds ratios (AOR) (and 95% confidence intervals) of GH and PE for chronic hypertension in the father or mother of pregnant women. Some differences were discovered. (1) Paternal hypertension (vs. absence of hypertension in the family) was an independent risk factor for GH (AOR-a = 1.98 (1.2–3.28), p = 0.008). This odds ratio increased in pregnant women who smoked in the first trimester (AOR-a = 4.71 (1.01–21.96); p = 0.048) or smoked before pregnancy (AOR-a = 3.15 (1.16–8.54); p = 0.024), or had pre-pregnancy overweight (AOR-a = 2.67 (1.02–7.02); p = 0.046). (2) Maternal hypertension (vs. absence of hypertension in the family) was an independent risk factor for preeclampsia (PE) (AOR-a = 3.26 (1.3–8.16); p = 0.012). This odds ratio increased in the obese women (AOR-a = 6.51 (1.05–40.25); p = 0.044) and (paradoxically) in women who had never smoked (AOR-a = 5.31 (1.91–14.8); p = 0.001). Conclusions: Chronic hypertension in the father or mother affected the risk of preeclampsia and gestational hypertension in different ways. Modifiable factors (overweight/obesity and smoking) may exacerbate the relationships in question, however, paradoxically, beneficial effects of smoking for preeclampsia risk are also possible. Importantly, paternal and maternal hypertension were not independent risk factors for GH/PE in a subgroup of women with normal body mass index (BMI).

Effect of stop smoking during the first trimester on Low birth weight: A MCBR Study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
O Kharkova ◽  
J Odland
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Public Health Problem ◽  
First Trimester ◽  
World Health ◽  
Antenatal Visit ◽  
Smoking During Pregnancy ◽  
Stop Smoking ◽  
Quitting Smoking ◽  
Term Baby

Abstract Background Tobacco smoking is a public health problem. Even though this habit is less common among women than men in Russia, it appears to be on the increase among women aged ≥15 years. Smoking during pregnancy leads to adverse pregnancy and birth outcomes. Compared to the number of studies on maternal smoking and birth weight, the influence of stop smoking on low birth weight is not well documented. The aim of the study was to assess an effect of quitting smoking during the first trimester on low birth weight. Methods The study is based on the Murmansk County Birth registry. Women who delivered a singleton pregnancy after 37 weeks of gestation were comprised to the study (N = 44,486). Smoking information was assessed at the first antenatal visit during pregnancy and self-reported and. Low birth weight was defined in according to the World Health Organization as Mean value minus 2 standard deviations for girls and boys separately. Using logistic regressions, we adjusted for maternal age, residence, ethnicity, education, marital status, alcohol abuse, year of delivery, body mass index, pregnancy diabetes, gestational age, and excessive weight gain. Results The prevalence of low birth weight was 1.1%. This adverse birth outcome was more prevalent in women who smoked during pregnancy (2.5%) in compared to those who stopped do it during pregnancy (0.8%) or did not smoke before and during pregnancy (0.9%) (p &lt; 0.001). Compared to non-smokers, quitting smoking during the first trimester had no significant impact on the low birth weight, even after adjustment for confounders (ORcrude = 0.97 with 95%CI 0.64-1.47 and ORadj = 0.89 with 95%CI 0.58-1.36). Conclusions We observed that women who stop smoking during the first trimester are at no greater risk of having a term baby with low birth weight. Our findings underline a continued need for actions against smoking during pregnancy. Key messages Women who stop smoking during the first trimester are at no greater risk of having a term baby with low birth weight. Our findings underline a continued need for actions against smoking during pregnancy.

Association Between Physical Activity in Parks and Perceived Environment: A Study With Adolescents

2009 ◽  
Vol 6 (4) ◽  
pp. 503-509 ◽  
Author(s):  
Rodrigo Siqueira Reis ◽  
Adriano Akira Ferreira Hino ◽  
Alex Antonio Florindo ◽  
Ciro Romélio Rodriguez Añez ◽  
Marlos Rodrigues Domingues
Keyword(s):  
Physical Activity ◽  
Logistic Regression ◽  
Odds Ratio ◽  
Multivariate Logistic Regression ◽  
Physically Active ◽  
Environmental Features ◽  
Perceived Environment ◽  
School Based ◽  
The Relationship ◽  
Crude Analysis

Background:The purpose of this study was to analyze the relationship between adolescents’ physical activity practice and their perception about the environment of urban parks.Methods:A school-based representative sample (n = 1,718; boys = 40.4%) of teenagers of Curitiba, Southern region of Brazil. A questionnaire was employed to identify perceived parks environmental features as well as physical activity practice in the parks (PAP), habitual physical activity (HPA) and demographics. The relationship between PAP and parks environments was analyzed through multivariate logistic regression controlling for age and socioeconomic status, HPA and parks distance.Results:After controlling for confounders PAP was associated with lack of space to be physically active, activities to choose from and equipments for both boys and girls, (odds ratio (OR)—ranging from 1.5 to 1.8). Among boys, having people of same age (OR = 1.5) and accessibility (OR = 2.0) showed association with PAP only in crude analysis. However, among girls, to be bulled or teased (OR = 1.4) and accessibility (OR = 1.7) were associated with PAP after confounding control.Conclusions:The results showed that specific attributes in parks may be considered and offered to increase the likelihood of physical activity practice among adolescents in such locations.

scholarly journals Association of early and late maternal smoking during pregnancy with offspring body mass index at 4 to 5 years of age

2015 ◽  
Vol 6 (6) ◽  
pp. 485-492 ◽  
Author(s):  
L. E. Grzeskowiak ◽  
N. A. Hodyl ◽  
M. J. Stark ◽  
J. L. Morrison ◽  
V. L. Clifton
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Maternal Smoking ◽  
South Australia ◽  
First Trimester ◽  
Z Score ◽  
Smoking During Pregnancy ◽  
Smoking In Pregnancy ◽  
Quitting Smoking ◽  
Maternal Smoking During Pregnancy

The objective was to investigate the association between early and late maternal smoking during pregnancy on offspring body mass index (BMI). We undertook a retrospective cohort study using linked records from the Women’s and Children’s Health Network in South Australia. Among a cohort of women delivering a singleton, live-born infants between January 2000 and December 2005 (n=7658), 5961 reported not smoking during pregnancy, 297 reported quitting smoking during the first trimester of pregnancy, and 1400 reported continued smoking throughout pregnancy. Trained nurses measured the height and weight of the children at preschool visits in a state-wide surveillance programme. The main outcome measure was age- and sex-specific BMI z-score. At 4 to 5 years, mean (s.d.) BMI z-score was 0.40 (1.05), 0.60 (1.07) and 0.65 (1.18) in children of mothers who reported never smoking, quitting smoking and continued smoking during pregnancy, respectively. Compared with the group of non-smokers, both quitting smoking and continued smoking were associated with an increase in child BMI z-score of 0.15 (95% confidence interval: 0.01–0.29) and 0.21 (0.13–0.29), respectively. A significant dose–response relationship was also observed between the number of cigarettes smoked per day on average during the second half of pregnancy and the increase in offspring BMI z-score (P<0.001). In conclusion, any maternal smoking in pregnancy, even if mothers quit, is associated with an increase in offspring BMI at 4 to 5 years of age.

scholarly journals Evaluation of the Relationship Between Types of Occupational Risk Factors and Pregnancy Induced Hypertension Among Iranian Employed Pregnant Women

2020 ◽  
Author(s):  
Nazanin Izadi ◽  
Omid Aminian ◽  
Pegah Estakhrian ◽  
Samaneh Akbarpour ◽  
Mahin Ahmadi Pishkuhi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Shift Work ◽  
Gestational Hypertension ◽  
Pregnancy Induced Hypertension ◽  
Related Factors ◽  
Cross Sectional ◽  
Occupational Risk Factors ◽  
Induced Hypertension ◽  
The Relationship

Gestational hypertension or pregnancy-induced hypertension is the emergence of hypertension in a pregnant women after 20 weeks of gestation. This study aimed to evaluate the job-related factors associated with pregnancy-induced hypertension. This cross-sectional study was conducted on 560 pregnant women who referred to the Nursing Clinic of Imam Khomeini Hospital in 2017; of all studied cases, 210 pregnant women with pregnancy-induced hypertension were selected as cases and 350 women without pregnancy-induced hypertension were selected as controls. The data on demographic characteristics, occupational characteristics, and ergonomic dangers were collected by the researchers. Finally, the relationship between job variables and the probability of developing hypertension in pregnant women was measured. The results of the logistic regression analysis showed that the variables of body mass index, fertility, shift work, and service works had a significant relationship with pregnancy-induced hypertension. Women with service work were 2.32 times more likely to develop hypertension than women with other types of jobs (P=0.013). The people who had a shift work were 2.28 times more likely to develop pregnancy-induced hypertension than those who did not have shift work. Based on the results of this study, there was no relationship between ergonomic risks and pregnancy-induced hypertension. It seems that due to the higher frequency of pregnancy-induced hypertension in highly demanding jobs, it is necessary to pay more attention to the assessment of related risk factors, such as psychological variables. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(7):430-434.

scholarly journals Biopsychosocial approach in studying the personality of women with different smoking behavior during pregnancy

2019 ◽  
pp. 86-92 ◽  
Author(s):  
O. K. Kharkova ◽  
A. G. Soloviev ◽  
J. O. Odland
Keyword(s):  
Economic Status ◽  
Smoking Behavior ◽  
First Trimester ◽  
Self Esteem ◽  
Married Women ◽  
Smoking During Pregnancy ◽  
Biopsychosocial Approach ◽  
Psychological Component ◽  
Maternity Hospitals ◽  
Quitting Smoking

The aim of the study was to explore the personality of women with different smoking behavior during pregnancy using a biopsychosocial approach. Women aged 18-38 years who were hospitalized in the maternity hospitals of Arkhangelsk were enrolled to the study. Pregnant women were divided into three groups depending on the tobacco history: “smokers”, “quitters” and “non-smokers”. As a result of the study, we determined variation in social, biological and psychological components of the personality of women with different smoking behavior during pregnancy. Thus, quitting smoking during pregnancy was more common in married women, and those who had a non-smoking father of the child. Women who stopped smoking during first trimester in compared to smokers were more introverted, had more frequently an instinct of “self-preservation” and “research”. Values of euphoric type of psychological component of gestational dominant and self-esteem were higher among women who stopped smoking during pregnancy in compared to smokers. Smokers in compared to non-smokers had a lower social and economic status, were more often extroverted, emotionally unstable, rigid, less often had a strong development of the instinct «procreation», «research», «altruism», but more often «liberty». Moreover, smokers showed higher rates of depressive, anxious of psychological component of gestational dominant and weaker development of self-esteem and will. So, the revealed features demonstrate those targets to which preventive measures should be directed.

scholarly journals First Trimester Serum Copper or Zinc Levels, and Risk of Pregnancy-Induced Hypertension

Nutrients ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 2479 ◽  
Author(s):  
Małgorzata Lewandowska ◽  
Stefan Sajdak ◽  
Wojciech Marciniak ◽  
Jan Lubiński
Keyword(s):  
Early Pregnancy ◽  
Odds Ratio ◽  
Inductively Coupled Plasma ◽  
Adjusted Odds Ratio ◽  
First Trimester ◽  
Pregnancy Induced Hypertension ◽  
Odds Ratios ◽  
Oxidative Balance ◽  
Induced Hypertension ◽  
Zinc Levels

Early identification of women at risk of developing pregnancy-induced hypertension (PIH) is very important. The involvement of copper (Cu) and zinc (Zn) in the oxidative balance suggests the possibility of their association with this disease, in which oxidative stress plays a key role. However, it has not been established so far whether the microelement levels in early pregnancy may be risk markers of the disease, as prospective studies are limited in number. In our innovative single-center study, we identified from a prospective cohort of healthy women in the 10–14th week of a single pregnancy: women subsequently developing pregnancy-induced hypertension (n = 121) and matched women remaining normotensive (n = 363). We measured the concentrations of microelements in the serum from 10–14 week, using the inductively coupled plasma mass spectrometry (ICP-MS). The odds ratios of the disease (and 95% confidence intervals) were assessed in logistic regression. In the whole cohort, the odds ratio (OR) of PIH was 1.52 (p = 0.174) for women in the lowest (Q1) quartile of Cu (≤1540.58 µg/L) compared with women in the highest (Q4) quartile (>1937.46 µg/L), but adjusted odds ratio (AOR) was 2.17 (p = 0.019) after adjusted for pre-pregnancy body mass index (BMI) and gestational age at recruitment. The higher levels of Cu in the subgroup of BMI ≥ 25 kg/m2 compared to normal BMI were found (1847.64 vs. 1673.36 µg/L; p < 0.0001). In the subgroup of women with the normal pre-pregnancy BMI, the adjusted odds ratio of PIH was AOR = 2.95 (p = 0.040) for Q1 vs. Q4 quartile. Our results suggest that lower Cu levels in early pregnancy may be connected with higher risk of PIH, but BMI affected estimated odds ratios. Zinc levels had no effect on the risk.

scholarly journals First Trimester Microelements and Their Relationships with Pregnancy Outcomes and Complications

Nutrients ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 1108 ◽  
Author(s):  
Małgorzata Lewandowska ◽  
Barbara Więckowska ◽  
Stefan Sajdak ◽  
Jan Lubiński
Keyword(s):  
Intrauterine Growth Restriction ◽  
Gestational Hypertension ◽  
First Trimester ◽  
Multivariate Logistic Regression ◽  
Maternal Characteristics ◽  
Financial Status ◽  
Intrauterine Growth ◽  
Prepregnancy Bmi ◽  
Oxidative Balance ◽  
Complete Set

Microelements involved in the oxidative balance have a significant impact on human health, but their role in pregnancy are poorly studied. We examined the relationships between first trimester levels of selenium (Se), iron (Fe), zinc (Zn), and copper (Cu), as well as maternal characteristics and pregnancy results. The data came from a Polish prospective cohort of women in a single pregnancy without chronic diseases. A group of 563 women who had a complete set of data, including serum microelements in the 10–14th week was examined, and the following were found: 47 deliveries <37th week; 48 cases of birth weight <10th and 64 newborns >90th percentile; 13 intrauterine growth restriction (IUGR) cases; 105 gestational hypertension (GH) and 15 preeclampsia (PE) cases; and 110 gestational diabetes mellitus (GDM) cases. The microelements were quantified using mass spectrometry. The average concentrations (and ranges) of the elements were as follows: Se: 60.75 µg/L (40.91–125.54); Zn: 618.50 µg/L (394.04–3238.90); Cu: 1735.91 µg/L (883.61–3956.76); and Fe: 1018.33 µg/L (217.55–2806.24). In the multivariate logistic regression, we found that an increase in Se of 1 µg/L reduces the risk of GH by 6% (AOR = 0.94; p = 0.004), the risk of IUGR by 11% (AOR = 0.89; p = 0.013), and the risk of birth <34th week by 7% (but close to the significance) (AOR = 0.93; p = 0.061). An increase in Fe of 100 µg/L reduces the risk of PE by 27% (AOR = 0.73; p = 0.009). In the multivariable linear regression, we found negative strong associations between prepregnancy BMI, Se (β = −0.130; p = 0.002), and Fe (β = −0.164; p < 0.0001), but positive associations with Cu (β = 0.320; p < 0.000001). The relationships between Se and maternal age (β = 0.167; p < 0.0001), Se and smoking (β = −0.106; p = 0.011) and Cu, and gestational age from the 10–14th week (β = 0.142; p < 0.001) were also found. Secondary education was associated with Zn (β = 0.132; p = 0.004) and higher education was associated with Cu (β = −0.102; p = 0.023). A higher financial status was associated with Fe (β = 0.195; p = 0.005). Other relationships were statistically insignificant. Further research is needed to clarify relationships between first trimester microelements and pregnancy complications. In addition, attention should be paid to lifestyle-related and socioeconomic factors that affect microelement levels.

scholarly journals Pregnancy-Induced Increases in the Nicotine Metabolite Ratio: Examining Changes During Antepartum and Postpartum

2018 ◽  
Vol 21 (12) ◽  
pp. 1706-1710 ◽  
Author(s):  
Christopher A Arger ◽  
Taraneh Taghavi ◽  
Sarah H Heil ◽  
Joan Skelly ◽  
Rachel F Tyndale ◽  
...  
Keyword(s):  
Time Course ◽  
Nicotine Patch ◽  
Controlled Trial ◽  
Late Pregnancy ◽  
First Trimester ◽  
Nicotine Metabolism ◽  
Smoking During Pregnancy ◽  
Quitting Smoking ◽  
Metabolite Ratio ◽  
Nicotine Metabolite Ratio

Abstract Introduction Pregnancy-induced increases in nicotine metabolism may contribute to difficulties in quitting smoking during pregnancy. However, the time course of changes in nicotine metabolism during early and late pregnancy is unclear. This study investigated how pregnancy alters the nicotine metabolite ratio (NMR), a common biomarker of nicotine metabolism among nonpregnant smokers. Methods Urinary NMR (trans-3′-hydroxycotinine [3HC]/cotinine [COT]) was assessed using total (free + glucuronide) and free compounds among women (N = 47) from a randomized controlled trial for smoking cessation who self-reported smoking and provided a urine sample during early pregnancy (M ± SD = 12.5 ± 4.5 weeks’ gestation), late pregnancy (28.9 ± 2.0 weeks’ gestation), and 6 months postpartum (24.7 ± 1.2 weeks since childbirth). Urine samples were analyzed using liquid chromatography–tandem mass spectrometry and NMR were calculated as Total 3HC/Free COT, Free 3HC/Free COT, and Total 3HC/Total COT. Results NMR was significantly higher during early and late pregnancy compared to postpartum and significantly increased from early to late pregnancy as measured by Total 3HC/Free COT (0.76, 0.89, 0.60; all p’s < .05) and Free 3HC/Free COT (0.68, 0.80, 0.51; all p’s < .05). Total 3HC/Total COT did not vary over time (p = .81). Conclusions Total 3HC/Free COT and Free 3HC/Free COT increased in the first trimester and continued to increase throughout pregnancy, suggesting a considerable increase in nicotine metabolism over gestation. Future analyses are needed to interpret the changes in NMR in the context of nicotine pharmacokinetics, as well as its impact on changes in smoking behavior and cessation outcomes. Implications We observed that the NMR was significantly higher as early as 12 weeks’ gestation and increased further as a function of gestational age. Among nonpregnant smokers, elevated NMR is associated with smoking phenotypes such as smoking more cigarettes per day and poorer response to nicotine patch; therefore, pregnancy-induced increases in the NMR may contribute to smoking during the first trimester of pregnancy and reducing or quitting smoking may become more challenging as the rate of nicotine metabolism accelerates over the course of pregnancy.

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