Impact of Smoking Exposure Change on Infant Birth Weight Among a Cohort of Women in a Prenatal Smoking Cessation Study

Despite the known harmful effects of smoking during pregnancy, the highly addicted find it difficult to quit. Decreased smoking may be regarded as a means of harm reduction. There is limited information on the benefits of smoking reduction short of quitting. This study used salivary cotinine to assess the impact of change in smoking exposure on birth weight in full-term infants. In a prenatal smoking cessation study, smoking status was validated by saliva cotinine at baseline and end of pregnancy (EOP). Salivary cotinine epsilon 15ng/ml defined active smoking. Based on salivary cotinine, women were grouped as nonsmoking/quit, light exposure (< 150ng/ml), and heavy exposure (epsilon 150ng/ml) at baseline and EOP. EOP and baseline smoking status were stratified to form smoking exposure change groups. Mean birth weight was compared among those who quit, reduced, maintained, and increased. Smoking cessation was associated with a 299g increase in birth weight compared with sustained heavy smoking, p .021. Reduced exposure from heavy to light was associated with a 199g increase in birth weight compared with sustained heavy exposure, a 103g increase compared with increased exposure, and a 63g increase compared with sustained light exposure. Differences among continuing smokers were not statistically significant. Although not statistically significant, the increase in infant birth weight associated with reduction from heavy to light exposure suggests potential for benefit. The only statistically significant comparison was between quitters and sustained heavy smokers, confirming that smoking cessation should remain the goal for pregnant women.