Cotinine Validation of Self-Reported Smoking During Pregnancy in the Swedish Medical Birth Register

Nicotine Tob Res. 2016 Jan;18(1):79-83. doi: 10.1093/ntr/ntv087. Epub 2015 Apr 20.


Introduction: Self-reported data on smoking during pregnancy from the Medical Birth Register of Sweden (MBR) are widely used. However, underreporting of such behavior may occur, leading to biases. It is of importance to validate the smoking data in the MBR. The main objective was to investigate the agreement between self-reported smoking data from the MBR and cotinine levels in maternal serum among women from the general population in the region of Skåne, Sweden. We also estimated the transfer of cotinine from mother to fetus.

Methods: From a cohort used previously to investigate the relationship between intrauterine environmental exposures and offspring neuropsychiatric outcomes, there were 204 control children retrieved from the MBR with data on maternal smoking in early pregnancy registered. Data on maternal and umbilical cord cotinine at delivery were available for these children from a regional biobank.

Results: There was a high agreement between cotinine levels and MBR smoking data (κ = 0.82) and a high correlation between cotinine levels in maternal and umbilical cord serum (r s = 0.90, P < .001). Of the self-reported nonsmokers, 95% (95% confidence interval: 89% to 97%) were classified as nonsmokers after cotinine measurements.

Conclusion: In these data, we found that the agreement between mothers' self-reported smoking habits during pregnancy and their levels of serum cotinine was high, as was the transfer of cotinine from mother to fetus. This indicates that birth register data on pregnancy smoking in Sweden could be considered a valid measure.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Cotinine / blood*
  • Female
  • Fetal Blood / chemistry
  • Humans
  • Maternal-Fetal Exchange
  • Pregnancy / blood*
  • Pregnancy / psychology
  • Prenatal Exposure Delayed Effects
  • Prevalence
  • Registries
  • Self Report*
  • Smoking / blood
  • Smoking / epidemiology*
  • Sweden / epidemiology
  • Young Adult


  • Cotinine