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Association between urinary cotinine level and hypertensive disorders of pregnancy in women with uterine myoma: findings from the Japan Environment and Children’s Study

Hypertension Research volume 48, pages 102–109 (2025)Cite this article

A Comment to this article was published on 05 December 2024

Abstract

The effect of smoking on hypertensive disorders of pregnancy is a public concern. Recent evidence suggests that the risk of hypertensive disorders of pregnancy is influenced by the presence of uterine fibroids. We explored the association between maternal smoking exposure and the risk of hypertensive disorders of pregnancy in relation to the presence of uterine fibroids using data from Japan’s largest birth cohort study. This study focused on first-time mothers, and the study population comprised 2752 and 35,294 first-time mothers with and without uterine fibroids, respectively. Hypertensive disorders of pregnancy was categorized as early-onset (before 34 weeks) and late-onset (after 34 weeks). Maternal smoking exposure was assessed by measuring the urinary cotinine concentration during the mid-trimester. Participants were classified into four quartiles based on their urinary cotinine levels as follows: Q1 (low concentration) to Q4 (high concentration). Multivariate analysis adjusted for potential confounders revealed that in women without uterine fibroids, the Q3 urinary cotinine level was associated with a modified risk of early-onset hypertensive disorders of pregnancy (adjusted odds ratio: 0.63, 95% confidence interval: 0.44–0.89). Conversely, for women with uterine fibroids, Q4 urinary cotinine level was associated with an increased risk of hypertensive disorders of pregnancy (adjusted odds ratio: 1.68, 95% confidence interval: 1.05–2.72). In conclusion, this study indicated that the impact of maternal smoking exposure varied based on the presence of uterine fibroids, underscoring the importance of personalized preconception care.

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Acknowledgements

The findings and conclusions of this article are solely the responsibility of the authors and do not represent the official views of the Ministry of the Environment. The authors are grateful to all participants in the study and members of the JECS Group as of 2023.

the Japan Environment and Children’s Study (JECS) Group

Michihiro Kamijima6, Shin Yamazaki7, Yukihiro Ohya8, Reiko Kishi9, Nobuo Yaegashi10, Koichi Hashimoto11, Chisato Mori12, Shuichi Ito13, Zentaro Yamagata14, Hidekuni Inadera15, Takeo Nakayama16, Tomotaka Sobue17, Masayuki Shima18, Seiji Kageyama19, Narufumi Suganuma20, Shoichi Ohga21, Takahiko Katoh22

Funding

This study was funded by the Ministry of Environment, Japan. The findings and conclusions of this article are solely the responsibility of the authors and do not represent the official views of the government.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan

    Hyo Kyozuka, Takahiro Omoto, Tsuyoshi Murata, Toma Fukuda, Chihiro Okoshi, Hirotaka Isogami, Shun Yasuda & Keiya Fujimori

  2. Fukushima Regional Center for the Japan Environmental and Children’s Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan

    Hyo Kyozuka, Takahiro Omoto, Tsuyoshi Murata, Toma Fukuda, Chihiro Okoshi, Hirotaka Isogami, Shun Yasuda, Akiko Sato, Yuka Ogata, Mitsuaki Hosoya, Seiji Yasumura, Koichi Hashimoto, Keiya Fujimori & Hidekazu Nishigori

  3. Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan

    Mitsuaki Hosoya & Koichi Hashimoto

  4. Department of Public Health, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan

    Seiji Yasumura

  5. Fukushima Medical Center for Children and Women, 1 Hikarigaoka, Fukushima, 960-1295, Japan

    Hidekazu Nishigori

  6. Nagoya City University, Nagoya, Japan

    Michihiro Kamijima

  7. National Institute for Environmental Studies, Tsukuba, Japan

    Shin Yamazaki

  8. National Center for Child Health and Development, Tokyo, Japan

    Yukihiro Ohya

  9. Hokkaido University, Sapporo, Japan

    Reiko Kishi

  10. Tohoku University, Sendai, Japan

    Nobuo Yaegashi

  11. Fukushima Medical University, Fukushima, Japan

    Koichi Hashimoto

  12. Chiba University, Chiba, Japan

    Chisato Mori

  13. Yokohama City University, Yokohama, Japan

    Shuichi Ito

  14. University of Yamanashi, Chuo, Japan

    Zentaro Yamagata

  15. University of Toyama, Toyama, Japan

    Hidekuni Inadera

  16. Kyoto University, Kyoto, Japan

    Takeo Nakayama

  17. Osaka University, Suita, Japan

    Tomotaka Sobue

  18. Hyogo College of Medicine, Nishinomiya, Japan

    Masayuki Shima

  19. Tottori University, Yonago, Japan

    Seiji Kageyama

  20. Kochi University, Nankoku, Japan

    Narufumi Suganuma

  21. Kyushu University, Fukuoka, Japan

    Shoichi Ohga

  22. Kumamoto University, Kumamoto, Japan

    Takahiko Katoh

Authors
  1. Hyo Kyozuka
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  2. Takahiro Omoto
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  3. Tsuyoshi Murata
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  4. Toma Fukuda
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  5. Chihiro Okoshi
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  6. Hirotaka Isogami
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  7. Shun Yasuda
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  8. Akiko Sato
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  9. Yuka Ogata
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  10. Mitsuaki Hosoya
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  11. Seiji Yasumura
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  14. Hidekazu Nishigori
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the Japan Environment and Children’s Study (JECS) Group

  • Michihiro Kamijima
  • , Shin Yamazaki
  • , Yukihiro Ohya
  • , Reiko Kishi
  • , Nobuo Yaegashi
  • , Koichi Hashimoto
  • , Chisato Mori
  • , Shuichi Ito
  • , Zentaro Yamagata
  • , Hidekuni Inadera
  • , Takeo Nakayama
  • , Tomotaka Sobue
  • , Masayuki Shima
  • , Seiji Kageyama
  • , Narufumi Suganuma
  • , Shoichi Ohga
  •  & Takahiko Katoh

Corresponding author

Correspondence to Hyo Kyozuka.

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Kyozuka, H., Omoto, T., Murata, T. et al. Association between urinary cotinine level and hypertensive disorders of pregnancy in women with uterine myoma: findings from the Japan Environment and Children’s Study. Hypertens Res 48, 102–109 (2025). https://doi.org/10.1038/s41440-024-01971-6

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  • DOI: https://doi.org/10.1038/s41440-024-01971-6

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