THE ACCURACY OF SELF-REPORT OF SMOKING STATUS IN PREGNANT-WOMEN

Little is known about the accuracy of usual-care providers' detection of pregnant smokers. This study explored the proportion of pregnant wo men misclassified as nonsmokers by midwives in a public antenatal clin ic. A sample of 204 women whom midwives classified as nonsmokers were asked to complete a self-administered questionnaire and to provide a u rine specimen for cotinine analysis. Results indicate that midwives fa iled to detect a significant proportion of smokers. The conservative e stimate of the proportion of midwife-identified nonsmokers who could b e reclassified as smokers on the basis of the questionnaire and urinal ysis procedures was 7.4% (95% CI 3.8-10.9%), the medium estimate was 8 .8% (95% CI 4.9-12.7%) and the worst-case estimate was 15.2% (95% CI 1 0.3-20.1%). To increase the cover age achieved by smoking-cessation pr ograms, antenatal clinics should consider incorporating biochemical me asurements into routine screening procedures. Future studies examining smoking status in pregnancy should detail the methods used to classif y subjects and document response rates in relation to each self-report and biochemical measurement.