The effects of prenatal secondhand smoke exposure on preterm birth and neonatal outcomes

Kristin B. Ashford, Ellen Hahn, Lynne Hall, Mary Kay Rayens, Melody Noland, James E. Ferguson

Research output: Contribution to journalArticlepeer-review

65 Scopus citations


Objective: To examine the relationship between prenatal secondhand smoke (SHS) exposure, preterm birth and immediate neonatal outcomes by measuring maternal hair nicotine. Design: Cross-sectional, observational design. Setting: A metropolitan Kentucky birthing center. Participants: Two hundred and ten (210) mother-baby couplets. Methods: Nicotine in maternal hair was used as the biomarker for prenatal SHS exposure collected within 48 hours of birth. Smoking status was confirmed by urine cotinine analysis. Results: Smoking status (nonsmoking, passive smoking, and smoking) strongly correlated with low, medium, and high hair nicotine tertiles (ρ=74; p<001). Women exposed to prenatal SHS were more at risk for preterm birth (odds ratio [OR]=2.3; 95% Confidence Interval [CI] [.96, 5.96]), and their infants were more likely to have immediate newborn complications (OR=2.4; 95% CI [1.09, 5.33]) than nonexposed women. Infants of passive smoking mothers were at increased risk for respiratory distress syndrome (RDS) (OR=4.9; 95% CI [1.45, 10.5]) and admission to a Neonatal Intensive Care Unit (NICU) (OR=6.5; CI [1.29, 9.7]) when compared to infants of smoking mothers (OR=3.9; 95% CI [1.61, 14.9]; OR=3.5; 95% CI [2.09, 20.4], respectively). Passive smokers and/or women with hair nicotine levels greater than .35 ng/ml were more likely to deliver earlier (1 week), give birth to infants weighing less (decrease of 200-300 g), and deliver shorter infants (decrease of 1.1-1.7 cm). Conclusions: Prenatal SHS exposure places women at greater risk for preterm birth, and their newborns are more likely to have RDS, NICU admissions, and immediate newborn complications.

Original languageEnglish
Pages (from-to)525-535
Number of pages11
JournalJOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
Issue number5
StatePublished - 2010

Bibliographical note

Funding Information:
Funded by a University of Kentucky Faculty Research Grant; a USPHS grant supporting the University of Kentucky General Clinical Research Center #M01RR02602; and Grant # K12DA14040 from the Office of Women's Health Research and the National Institute on Drug Abuse at the National Institutes of Health (NIH). The contents are solely the responsibility of the authors and do not necessarily represent the official views of NIH. The authors thank Graeme Mahoney, HSO, Specialist Biochemistry Laboratory, Wellington Hospital, Wellington, New Zealand, for analyzing nicotine in hair.


  • Hair nicotine biomarkers
  • Preterm birth
  • Secondhand smoke exposure
  • Smoking and pregnancy

ASJC Scopus subject areas

  • Pediatrics
  • Critical Care
  • Maternity and Midwifery


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