Prenatal Research Unit, Department of Clinical Biochemistry, King George Hospital, Barley Lane, Goodmayes, IG3 8YB, UK.
Prenat Diagn. 2013 Mar;33(3):245-50. doi: 10.1002/pd.4053. Epub 2013 Jan 25.
To review the accuracy of self-reporting of smoking status in our first trimester screening population and to assess the levels of pregnancy-associated plasma protein-A (PAPP-A) and free-β human chorionic gonadotropin (free-hCGβ) in women who were classified for smoking status by serum cotinine concentrations and self-reporting.
Cotinine concentration was determined in the stored serum 696 self-reported smokers and 442 self-reported non-smokers. PAPP-A and free-hCGβ multiples of the medians (MoMs) determined at screening were reverted to uncorrected for self-reported smoking status.
A total of 21.7% of those self-reporting as non-smokers had increased serum cotinine concentrations (using a cut-off of 13.7 ng/mL), indicating a positive smoking status. This under-reporting meant that serum PAPP-A and free-hCGβ MoMs were greater reduced in smokers classified by cotinine levels (17.2% and 9.7%) than in those classified by self-reporting (14.6% and 2.8%). Women who were classified as smokers at conception but had stopped at some time afterwards did not have significantly reduced marker MoMs to non-smokers.
Self-reporting results in under-representation of smoking in our population, resulting in a significant bias and inflated screen-positive rates.
回顾我们的早孕期筛查人群中自我报告吸烟状况的准确性，并评估通过血清可替宁浓度和自我报告来分类吸烟状况的女性的妊娠相关血浆蛋白-A（PAPP-A）和游离-β人绒毛膜促性腺激素（游离-hCGβ）水平。
在 696 名自我报告的吸烟者和 442 名自我报告的不吸烟者中，测定了储存的血清中的可替宁浓度。在筛查时确定的 PAPP-A 和游离-hCGβ 中位数倍数（MoM）被反转，未校正自我报告的吸烟状况。
自我报告为不吸烟者的人群中，有 21.7%的人血清可替宁浓度升高（使用 13.7ng/mL 的截断值），表明有阳性吸烟状况。这种漏报意味着根据可替宁水平分类的吸烟者的血清 PAPP-A 和游离-hCGβ MoM 降低幅度更大（17.2%和 9.7%），而不是根据自我报告分类的吸烟者（14.6%和 2.8%）。在受孕时被归类为吸烟者但随后在某个时间停止吸烟的女性，其标志物 MoM 与非吸烟者相比并没有明显降低。
自我报告导致我们人群中吸烟状况的代表性不足，从而导致了显著的偏差和虚报的筛查阳性率。
