49 to 56 (Burling & Burling, 2003; de Meneses-Gaya et al , 2009)

49 to .56 (Burling & Burling, 2003; de Meneses-Gaya et al., 2009). Relationship Between Blood and Salivary Cotinine Similar to analyses conducted in nonpregnant smokers, blood and salivary cotinine http://www.selleckchem.com/products/17-AAG(Geldanamycin).html in pregnant smokers were closely related (Jarvis et al., 2003; Tricker, 2006). Although BMI was found to influence the relationship between blood and salivary cotinine in pregnant smokers, it did not alter the regression coefficient substantially. The effect of age on the relationship found in studies of nonpregnant smoker (Jarvis et al., 2003) was not noted in our study; however, as all participants in our study were pregnant, the range of their ages was restricted, which could explain this difference. Interestingly, the ratio of salivary to blood cotinine levels in our sample of pregnant smokers was around unity.

This contrasts to findings of a recent review (Tricker, 2006), which reported the range of salivary:plasma cotinine ratio in nonpregnant smokers as 1.1�C1.4, with most empirical studies being small or having wide CIs (Bernert, McGuffey, Morrison, & Pirkle, 2000; Machacek & Jiang, 1986; van Vunakis et al., 1989). The largest study included in the review (Jarvis et al., 2003) included 270 female nonpregnant smokers and found a ratio of salivary to plasma cotinine of 1.23 (95% CI 1.21�C1.25). Although this study used plasma cotinine analyzed by gas chromatography rather than blood cotinine measured by liquid chromatography, blood samples from this study and from ours were processed by the same laboratory, and no difference in cotinine levels due to variation in sample analysis method was expected (Bernert et al.

, 2009). Hence, it seems appropriate that in samples of pregnant women, mean salivary and blood cotinine values can be treated virtually interchangeable. The closer relationship between salivary and blood cotinine levels observed in our pregnant sample may be due to the effects of hormonal changes in pregnancy on saliva characteristics and composition. The rise in estrogen in pregnancy may lower the pH and buffer capacity of saliva in pregnant women, affecting absorption of cotinine (Laine et al., 1988; Lukacs & Largaespada, 2006; Rebagliato et al., 1998). An alternative explanation may be that the increased nicotine metabolism in pregnancy (Rebagliato et al., 1998; Tricker, 2006) may affect salivary cotinine more than blood cotinine leading to the lower ratio, and further research is required.

SUMMARY Our study had shown that HSI is a valid, brief measure of nicotine dependence in pregnancy, producing comparable results and psychometric properties to those observed in nonpregnant smokers. Future studies involving pregnant smokers can routinely incorporate HSI as a measure of nicotine Entinostat dependence and, if preferred, cotinine assays can be performed using salivary samples rather than blood samples because these produce roughly equivalent cotinine values and obtaining saliva samples is less invasive.

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