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Smoking during pregnancy is a preventable cause of infant morbidity and mortality, yet prenatal smoking is a persistent problem, with an estimated 6–22% of women in high-income countries reporting smoking cigarettes during pregnancy.1 Clinic-based interventions are effective in increasing cessation and improving pregnancy outcomes2; however, delivery of these interventions depends on the ability of providers to assess a woman's smoking status and readiness to quit accurately.
Shipton and colleagues sought to estimate the biochemically validated prevalence of women in need of smoking cessation services. Using a random sample of all 2004 births from the West of Scotland, they compared routinely collected self-reported smoking status of pregnant women at maternity booking (8–12 weeks of gestation) and serum cotinine levels from prenatal screening (15–16 weeks of gestation). They found that maternal self-reported smoking status underestimated smoking prevalence by 25%. The authors' findings are consistent with previously published clinical and observational studies in which maternal …
Competing interests The authors report no competing interests. The findings and conclusions are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.