Assessing nicotine metabolism in pregnancy - A novel approach using hair analysis

Nicotine and its metabolite cotinine are important biochemical markers to determine active or passive exposure to cigarette smoke. The amount of nicotine and cotinine in hair provides a cumulative index of tobacco exposure. This study uses segmental hair analysis to assess changes in nicotine metabolism in a cohort of pregnant women who smoked steadily during the whole gestational period according to their self-report. Maternal hair was collected at the time of delivery and sectioned into segments representing the three trimesters of pregnancy. The concentrations of nicotine and cotinine in each section of hair were measured by radioimmunoassay. Hair concentration of nicotine decreased during pregnancy without any reported reduction in smoking, while the cotinine concentration remained constant. The nicotine-cotinine ratio in these consistent smokers was: 1st trimester 20.6, 2nd trimester 19.9, and 3rd trimester 13.3. These findings are consistent with results from other studies showing increased nicotine metabolism during pregnancy. Our data suggest that the results of segmental hair analysis should be carefully examined in pregnancy. Both nicotine and cotinine levels should be evaluated in order to confirm any significant change in maternal tobacco exposure during pregnancy.