Riverside Prenatal Biomonitoring Pilot Project:
Results for cotinine
June 2011 Report to the Community
What is the Riverside Prenatal Biomonitoring Pilot Project?
The Minnesota Department of Health conducted this project to measure certain chemicals in the urine of
pregnant women. Chemicals included environmental phenols, used in plastics and personal care products,
and cotinine, which indicates exposure to tobacco. This is a small pilot project, designed in part to help
MDH learn how best to do biomonitoring projects in the future. The project involved 66 women who
participated in the Riverside Birth Study conducted by the University of Minnesota in 2009-2010 at Fairview
Riverside Hospital.
What is cotinine? How does it end up in urine?
Nicotine, found in tobacco products like cigarettes, breaks down into cotinine in the human body. Cotinine
shows how much exposure a person has had to tobacco smoke or other tobacco products.
Higher levels of cotinine in urine indicate that a person is probably an active smoker. Lower levels of
cotinine in urine suggest a person is a very light smoker or a non-smoker who has been exposed to tobacco
smoke through secondhand smoke (environmental tobacco smoke).
Does cotinine harm people’s health?
Cotinine itself is not harmful to people’s health – it simply tells us whether a person has been exposed to
tobacco smoke. Tobacco smoke, on the other hand, contains many chemicals that are harmful.
Smoking during pregnancy can cause:
Pregnancy complications, such as problems with the placenta
Premature birth
Low birth weight
Stillbirth
In babies and children, exposure to secondhand smoke can cause:
More frequent and more severe asthma attacks in children who already have asthma
Respiratory infections, such as bronchitis and pneumonia
Ear infections
Sudden infant death syndrome (SIDS)
In adults, exposure to tobacco smoke through smoking or secondhand smoke can cause:
Many types of cancer, including lung, stomach, kidney, and bladder cancer
Heart disease, including heart attacks and strokes
Respiratory problems, including emphysema and chronic bronchitis
What can I do to protect myself and my family from secondhand smoke?
If you smoke, the best thing you can do is to quit smoking. For help quitting, call 1-888-354-PLAN (7526) or
go to quitplan.com. Until then, you can protect your family by smoking only outside. Opening a window in
the house or car or sitting in a separate room when you smoke will NOT get rid of secondhand smoke.
You and your family can avoid secondhand smoke by staying away from people who are smoking:
Make your home and car smoke-free
Ask people not to smoke around you and your children
Make sure your children’s day care center is smoke-free
What did we learn about exposure to tobacco smoke from the Riverside Prenatal Biomonitoring Pilot Project?
Number of participants with and without cotinine detected in urine
Of the 66 women who took part in this
project, ten (15%) had cotinine detected
in their urine (see graph to the left). Nine
of the women (14%) were likely active
smokers.1 Among the women who had
detectable cotinine in their urine, levels
ranged from 129 nanograms per milliliter
of urine (or ng/mL) to over 1400 ng/mL.
Fifty-six women (85%) did not have
cotinine detected in their urine. They
were either not exposed to tobacco
smoke or exposed to low levels through
secondhand smoke.
Other studies in different groups of people have found that smoking and exposure to tobacco smoke differ
by income level. This project saw a similar relationship: women with lower household incomes were more
likely to have cotinine detected in their urine.
The cotinine measurement from a single urine sample reflects only the most recent exposure to tobacco
smoke: most cotinine in urine leaves the body within a day or two. Other women in this project could have
been exposed to tobacco smoke before or after the urine samples were collected, or could have had low
exposures below the limit of detection. Frequent or continuous exposure to tobacco smoke is more harmful
than less regular exposure.
How do participants in the Riverside Prenatal Biomonitoring Pilot Project compare to others?
According to U.S. data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES),
13% of pregnant women were active smokers, as determined by self-reported information and blood levels
of cotinine. In Minnesota, 13.8% of pregnant women with babies born in 2008 were estimated to have
smoked during pregnancy, as measured by self-reported information from the Minnesota Pregnancy Risk
Assessment Monitoring Survey (MN PRAMS) and birth certificates.
Results from this project are comparable: 14% of pregnant women in the project were classified as active
smokers based on cotinine and nicotine levels in urine.
What public health actions are being taken to reduce exposure to tobacco smoke?
Since the 1970s, the Minnesota Department of Health, state health insurance providers, and non-profit
organizations like the American Cancer Society, the American Lung Association, and the Association for
Nonsmokers - MN have been working to reduce harm caused both by smoking and exposure to secondhand
smoke. Minnesota was one of the first states to adopt smoke-free worksite legislation, and has been a
leader in promoting smoke-free multi-unit housing and outdoor spaces. By promoting the adoption of
tobacco-free policies, initiating programs to help people quit using tobacco, and funding a Tobacco Free
Communities Grant Program, Minnesota continues its commitment to reduce the harm caused by tobacco.
1
This is based on the MedTox Laboratory definition of active smokers as those with cotinine plus nicotine levels above 200 ng/mL. The limit of
detection for the cotinine test (the level below which results cannot be reliably measured) was 20 ng/mL.
2
A set of national goals, Healthy People 2020, includes objectives to:
Reduce tobacco use by adults and adolescents
Increase smoking cessation attempts and success by adult smokers
Increase the number of people who have smoke-free workplaces
Reduce the number of nonsmokers exposed to secondhand smoke
Increase the number of tobacco-free schools and homes
Where can I get more information on reducing exposure to tobacco smoke?
The MDH Tobacco Prevention and Control website provides links to many resources for people
interested in ending tobacco use: www.health.state.mn.us/divs/hpcd/tpc
Minnesota’s Live Smoke Free website offers information on how to find and promote smoke-free
apartment buildings: www.mnsmokefreehousing.org
The Healthy People 2020 website includes national objectives and additional resources related to
tobacco: www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=41
Resources for quitting smoking are available at www.quitplan.com
For more information, contact the Environmental Health Tracking
and Biomonitoring Program at the Minnesota Department of Health.
Call: (651) 201-5900 or (800) 205-4987
Email: [email protected]
Visit: www.health.state.mn.us/tracking
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