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The current study aimed to compare the utility of self\u2010reported CPD, total nicotine equivalents (TNE) and urinary cotinine to estimate nicotine intake during pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Longitudinal smoking behavior and biomarker data were collected at early pregnancy, late pregnancy and at postpartum as part of a smoking cessation trial to examine voucher\u2010based incentives for decreasing smoking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Obstetric practices in Burlington, Vermont, United States.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>A subset of participants (<jats:italic>n<\/jats:italic>\u00a0=\u00a047) from the parent trial, recruited between December 2006 and June 2012, who provided a urine sample at each assessment during early pregnancy, late pregnancy and postpartum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Smoking was assessed using self\u2010reported CPD, TNE, TNE\/CPD and urinary cotinine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Pregnant smokers reported smoking 10.4 CPD at early pregnancy, 7.2 CPD at late pregnancy (a 31% reduction at late pregnancy,<jats:italic>P<\/jats:italic>\u00a0=\u00a00.001) and 8.6 CPD at postpartum (a 19% increase from late pregnancy,<jats:italic>P<\/jats:italic>\u00a0=\u00a00.08). TNE exposure was 41% (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.07) and 48% (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.03) lower at early and late pregnancy, respectively, compared to postpartum. TNE\/CPD was on average 167% higher at late pregnancy compared to early pregnancy (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.01) and remained high at postpartum, where it was 111% higher compared to early pregnancy (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.007). Uriniary cotinine underestimated nicotine intake by 55% during early pregnancy and by 65% during late pregnancy compared to postpartum (<jats:italic>P<\/jats:italic><jats:sub><jats:italic>interaction<\/jats:italic><\/jats:sub>\u00a0&lt;\u00a00.001); the underestimation was greater in slower (<jats:italic>P<\/jats:italic><jats:sub><jats:italic>interaction<\/jats:italic><\/jats:sub>\u00a0&lt;\u00a00.001) versus faster (<jats:italic>P<\/jats:italic><jats:sub><jats:italic>interaction<\/jats:italic><\/jats:sub>\u00a0=\u00a00.04) nicotine metabolizers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Neither cigarettes smoked per day (CPD) nor cotinine provides an accurate estimate of nicotine exposure during pregnancy. CPD underestimates nicotine intake substantially due to under\u2010reporting and\/or higher intensity of smoking, while cotinine underestimates nicotine intake markedly due to accelerated nicotine (and cotinine) metabolism during pregnancy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.14367","type":"journal-article","created":{"date-parts":[[2018,6,19]],"date-time":"2018-06-19T20:16:28Z","timestamp":1529439388000},"page":"2087-2096","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Cigarette consumption and biomarkers of nicotine exposure during pregnancy and postpartum"],"prefix":"10.1111","volume":"113","author":[{"given":"Taraneh","family":"Taghavi","sequence":"first","affiliation":[{"name":"Department of Pharmacology and Toxicology University of Toronto Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher A.","family":"Arger","sequence":"additional","affiliation":[{"name":"Center on Tobacco Regulatory Science University of Vermont Burlington VT USA"},{"name":"Department of Psychiatry University of Vermont Burlington VT USA"},{"name":"Department of Psychological Science University of Vermont Burlington VT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah H.","family":"Heil","sequence":"additional","affiliation":[{"name":"Center on Tobacco Regulatory Science University of Vermont Burlington VT USA"},{"name":"Department of Psychiatry University of Vermont Burlington VT USA"},{"name":"Department of Psychological Science University of Vermont Burlington VT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen T.","family":"Higgins","sequence":"additional","affiliation":[{"name":"Center on Tobacco Regulatory Science University of Vermont Burlington VT USA"},{"name":"Department of Psychiatry University of Vermont Burlington VT USA"},{"name":"Department of Psychological Science University of Vermont Burlington VT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1297-2053","authenticated-orcid":false,"given":"Rachel F.","family":"Tyndale","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Toxicology University of Toronto Toronto ON Canada"},{"name":"Department of Psychiatry University of Toronto Toronto ON Canada"},{"name":"Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,7,23]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.3.361"},{"key":"e_1_2_7_3_1","first-page":"30277","article-title":"Tobacco and nicotine delivery product use in a national sample of pregnant women","volume":"5","author":"Kurti A. 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