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Urinary cotinine cut-off value in categorising cigarette smoking status in healthy pregnant women at term Cover

Urinary cotinine cut-off value in categorising cigarette smoking status in healthy pregnant women at term

Open Access
|Dec 2025

Figures & Tables

Figure 1

Distribution of (log-scaled) urinary cotinine concentrations in pregnant women at term (n=156) grouped by self-reported smoking habits and expressed as A) µg/L and B) µg/g creatinine
Distribution of (log-scaled) urinary cotinine concentrations in pregnant women at term (n=156) grouped by self-reported smoking habits and expressed as A) µg/L and B) µg/g creatinine

Figure 2

Association between the number of cigarettes smoked per day and (log-scaled) urinary cotinine concentrations in participants who reported smoking during pregnancy (n=33), expressed as A) µg/L and B) µg/g creatinine
Association between the number of cigarettes smoked per day and (log-scaled) urinary cotinine concentrations in participants who reported smoking during pregnancy (n=33), expressed as A) µg/L and B) µg/g creatinine

Figure 3

Receiver operating characteristic (ROC) curves describing cut-off values for urinary cotinine, expressed as A) µg/L and B) µg/g creatinine, that distinguish non-smoking from smoking healthy pregnant women at term
Receiver operating characteristic (ROC) curves describing cut-off values for urinary cotinine, expressed as A) µg/L and B) µg/g creatinine, that distinguish non-smoking from smoking healthy pregnant women at term

General characteristics and urinary cotinine values in pregnant women at term grouped by self-reported smoking habits

Non-smokers (n=123)Smokers (n=33)p
Age (years)33 (21–44)29 (21–38)<0.001
Educationa <0.001
  Primary7 (5.7 %)3 (9.1 %)
  Secondary47 (38.2 %)24 (72.7 %)
  Tertiary69 (56.1 %)6 (18.2 %)
Pre-pregnancy BMI22.9 (14.7–36.3)23.0 (16.0–36.6)0.469
Former smokers52 (42.2 %)/
Number of cigarettes smoked per day during pregnancy/7 (1–20)
Urinary cotinine (µg/L)2.30 [<LOD–6.70]1034 [611–2668]<0.001
Urinary cotinine (µg/g creatinine)2.06 [<LOD–9.55]1305 [420–2096]<0.001

Second-hand smoke (SHS) exposure and urinary cotinine in non-smoking pregnant women at term

Non-smokers reporting no exposure to SHS (n=82)Non-smokers reporting exposure to SHS (n=35)p
Age (years)34 (21–44)31 (21–37)0.002
Educationa 0.017
  Primary2 (2.4%)3 (8.6%)
  Secondary26(31.7%)18 (51.4%)
  Tertiary54 (65.9%)14 (40.0%)
Urinary cotinine (μg/L)1.00 [<LOD–4.20]6.50 [1.40–23.8]<0.001
Urinary cotinine (µg/g creatinine)1.08 [<LOD–4.09]7.05 [1.48–22.2]<0.001

Misclassification rates of self-reported smoking status with urinary cotinine concentrations based on the identified urinary cotinine cut-off values (120 µg/L and 144 µg/g creatinine) in pregnant women at term

Non-smokers with cotinine <120 µg/L (n=120)Smokers with cotinine >120 µg/L (n=36)Non-smokers with cotinine <144 µg/g creatinine (n=121)Smokers with cotinine >144 µg/g creatinine (n=35)
Ratio to self-reported
Non-smokers118/123 (95.9 %)5/123 (4.1 %)119/123 (96.7 %)4/123 (3.3 %)
Smokers2/33 (6.1 %)31/33 (93.9 %)2/33 (6.1 %)31/33 (93.9 %)
Urinary cotinine (μg/L)2.15 [<LOD–5.95]994 [577–2562]2.20 [<LOD–6.00]1034 [598–2668]
Urinary cotinine (µg/g creatinine)2.02 [<LOD–6.88]1315 [440–2194]2.03 [<LOD–7.05]1324 [460–2292]
DOI: https://doi.org/10.2478/aiht-2025-76-4052 | Journal eISSN: 1848-6312 | Journal ISSN: 0004-1254
Language: English, Croatian, Slovenian
Page range: 251 - 258
Submitted on: Oct 1, 2025
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Accepted on: Dec 1, 2025
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Published on: Dec 30, 2025
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2025 Nataša Brajenović, Irena Brčić Karačonji, Andreja Jurič, Jelena Kovačić, Sandra Stasenko, Tatjana Mioč, Iva Miškulin, Lana Škrgatić, Martina Piasek, Jasna Jurasović, published by Institute for Medical Research and Occupational Health
This work is licensed under the Creative Commons Attribution 4.0 License.