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Am J Perinatol 2024; 41(S 01): e119-e125
DOI: 10.1055/s-0042-1750407
Original Article

The Association between Prenatal Nicotine Exposure and Offspring's Hearing Impairment

Erin M. Cleary 
1   Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Douglas A. Kniss
1   Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Lida M. Fette
2   George Washington University Biostatistics Center, Washington, District of Columbia
,
Brenna L. Hughes
3   Brown University, Providence, Rhode Island
,
George R. Saade
4   University of Texas Medical Branch, Galveston, Texas
,
Mara J. Dinsmoor 
5   Northwestern University, Chicago, Illinois
,
Uma M. Reddy
6   the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Cynthia Gyamfi-Bannerman
7   Columbia University, New York, New York
,
Michael W. Varner 
8   University of Utah Health Sciences Center, Salt Lake City, Utah
,
William H. Goodnight
9   University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Alan T. N. Tita
10   University of Alabama at Birmingham, Birmingham, Alabama
,
Geeta K. Swamy
11   Duke University, Durham, North Carolina
,
Kent D. Heyborne
12   University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
,
Edward K. Chien
13   Case Western Reserve University, Cleveland, Ohio
,
Suneet P. Chauhan
14   University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas
,
Yasser Y. El-Sayed
15   Stanford University, Stanford, California
,
Brian M. Casey
16   University of Texas Southwestern Medical Center, Dallas, Texas
,
Samuel Parry
17   University of Pennsylvania, Philadelphia, Pennsylvania
,
Hyagriv N. Simhan
18   Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of Pittsburgh, Pittsburgh, Pennsylvania
,
Peter G. Napolitano
19   Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, District of Columbia
,
for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network › Author Affiliations Funding This work was supported by grants (HD40500, HD36801, HD53097, HD40512, HD40485, HD34208, HD40560, HD27869, HD27915, HD68258, HD68282, HD40544, HD40545, HD68268, HD34116, HD87192, and HD87230) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Center for Advancing Translational Sciences (UL1TR001873 and UL1TR000040). Both Cytogam and AlbuRx were provided by CSL Behring, Inc., free of charge. The company had no involvement in the data management, analysis, or preparation of this manuscript. The views expressed are those of the author(s) and do not represent the official views of or the official policy of the National Institutes of Health, the Department of the Army, the Department of Defense, or the U.S. Government. The investigators have adhered to the policies for the protection of human subjects as prescribed in 45 CFR 46.
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Abstract

Objectives The objective of this study is to evaluate whether there is an association between in-utero exposure to nicotine and subsequent hearing dysfunction.

Materials and Methods Secondary analysis of a multicenter randomized trial to prevent congenital cytomegalovirus (CMV) infection among gravidas with primary CMV infection was conducted. Monthly intravenous immunoglobulin hyperimmune globulin therapy did not influence the rate of congenital CMV. Dyads with missing urine, fetal or neonatal demise, infants diagnosed with a major congenital anomaly, congenital CMV infection, or with evidence of middle ear dysfunction were excluded. The primary outcome was neonatal hearing impairment in one or more ears defined as abnormal distortion product otoacoustic emissions (DPOAEs; 1 to 8 kHz) that were measured within 42 days of birth. DPOAEs were interpreted using optimized frequency-specific level criteria. Cotinine was measured via enzyme-linked immunosorbent assay kits in maternal urine collected at enrollment and in the third trimester (mean gestational age 16.0 and 36.7 weeks, respectively). Blinded personnel ran samples in duplicates. Maternal urine cotinine >5 ng/mL at either time point was defined as in-utero exposure to nicotine. Multivariable logistic regression included variables associated with the primary outcome and with the exposure (p < 0.05) in univariate analysis.

Results Of 399 enrolled patients in the original trial, 150 were included in this analysis, of whom 46 (31%) were exposed to nicotine. The primary outcome occurred in 18 (12%) newborns and was higher in nicotine-exposed infants compared with those nonexposed (15.2 vs. 10.6%, odds ratio [OR] 1.52, 95% confidence interval [CI] 0.55–4.20), but the difference was not significantly different (adjusted odds ratio [aOR] = 1.0, 95% CI 0.30–3.31). This association was similar when exposure was stratified as heavy (>100 ng/mL, aOR 0.72, 95% CI 0.15–3.51) or mild (5–100 ng/mL, aOR 1.28, 95% CI 0.33–4.95). There was no association between nicotine exposure and frequency-specific DPOAE amplitude.

Conclusion In a cohort of parturients with primary CMV infection, nicotine exposure was not associated with offspring hearing dysfunction assessed with DPOAEs.

Key Points

  • Nicotine exposure was quantified from maternal urine.

  • Nicotine exposure was identified in 30% of the cohort.

  • Exposure was not associated with offspring hearing dysfunction.

Keywords

neonatal hearing impairment - prenatal nicotine exposure - newborn hearing screening

Note

Presented at the 41st Annual Meeting of the Society for Maternal Fetal Medicine 2021.


* The other members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network are listed in the Appendix.




Publication History

Received: 13 April 2022

Accepted: 20 April 2022

Article published online:
25 August 2022

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