Evaluation of the accuracy of self-reported smoking in pregnancy when the biomarker level in an active smoker is uncertain
Evaluation of the accuracy of self-reported smoking in pregnancy when the biomarker level in an active smoker is uncertain
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DOI：
10.1093/ntr/ntp048
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发表时间：
2009-06-01
影响因子：
4.7
通讯作者：
LeGatt, Don
中科院分区：
文献类型：
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作者：
Burstyn, Igor;Kapur, Nitin;LeGatt, Don
我们的主要目标是评估在加拿大埃德蒙顿怀孕15-16周的孕妇中吸烟的流行率以及自我报告吸烟的敏感度、特异度、阳性预测值(PPV)和阴性预测值(NPV)。我们使用血清样本收集了一组接受选择性中期染色体和发育异常筛查的孕妇。我们用改良的尿可替宁测定法测定了92名自我报告的吸烟者(队列的11%)和285名自我报告的不吸烟母亲的可替宁浓度。自我报告是在交付时收集的。在一项验证研究中，确定了已知吸烟者和不吸烟者的血清可替宁，并在贝叶斯统计框架内使用，以定义区分真正吸烟者和不吸烟者的临界点的分布。用此临界点分布构建多个2×2表，得到敏感性、特异性、PPV、NPV和患病率的分布，敏感性较差(M=47.4%，SD=17.3%)，但特异性接近完美(M=94.9%，SD=1.1%)。PPV(M=66.6%，SD=11.7%)小于NPV(M=84.7%，SD=14.3%)。在我们的样本中，妊娠15-16周的真实吸烟率呈偏态分布，平均值为21.6%(SD=13.8%)，中位数为16.6%。本研究的力度包括让受试者盲目地测试其血清吸烟的生物标志物。一个限制是使用非随机样本，仅限于导致活产的怀孕。我们讨论了数据收集方法，以获得更准确的孕妇吸烟史。
Our main objective was to estimate smoking prevalence as well as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of self-reported smoking among pregnant women in Edmonton, Canada, at 15-16 weeks of gestation.We used serum samples to assemble a cohort of pregnant women who underwent an optional second-trimester screening for chromosomal and developmental anomalies. We determined cotinine concentrations for 92 self-reported smokers (11% of the cohort) and for 285 self-reported nonsmoking mothers, using adapted urinary cotinine assay. Self-reports were collected at the time of delivery. In a validation study, serum cotinine was determined for known smokers and nonsmokers and used, within a Bayesian statistical framework, to define the distribution of cutoffs that differentiate true smokers from nonsmokers. This distribution of cutoffs was used to construct multiple two-by-two tables to obtain the distribution of sensitivity, specificity, PPV, NPV, and prevalence.Sensitivity was poor (M = 47.4%, SD = 17.3%), but specificity was nearly perfect (M = 94.9%, SD = 1.1%). PPV (M = 66.6%, SD = 11.7%) was smaller than NPV (M = 84.7%, SD = 14.3%). In our sample, the prevalence of true smoking at 15-16 weeks of gestation was described by a skewed distribution with a mean of 21.6% (SD = 13.8%) and a median of 16.6%.The strength of the present study includes blinding of subjects to the intention to test their sera for a biomarker of smoking. A limitation was the use of a nonrandom sample restricted to pregnancies that resulted in live births. We discuss data collection methods that would elicit more accurate smoking histories from pregnant women.