Smoking, HIV, and risk of pregnancy loss

• Type of Material: Article
• Authors: Daniel Westreich, University of North Carolina at Chapel Hill; Jordan Cates, University of North Carolina at Chapel Hill; Mardge Cohen, Rush Medical College; Kathleen M. Weber, Cook County Health & Hospital Systems; Dominika Seidman, University of California San Francisco; Karen Cropsey, University of Alabama at Birmingham; Rodney Wright, Montefiore Medical Center; Joel Milam, University of Southern California; Mary A. Young, Georgetown University; Cyra Mehta, Emory University; Deborah R. Gustafson, State University of New York–Brooklyn; Elizabeth T. Golub, Johns Hopkins Bloomberg School of Public Health; Margaret A. Fischl, University of Miami Miller School of Medicine; Adaora A. Adimora, University of North Carolina at Chapel Hill
• Language: English
• Date: 2016-11-29
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Final Published Version
• Copyright Statement: Copyright © 2016 Wolters Kluwer Health, Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/QAD.0000000000001342
• Title of Journal or Parent Work: AIDS
• ISSN: 0269-9370
• Volume: 31
• Issue: 4
• Start Page: 553
• End Page: 560
• Grant/Funding Information: Design and conduct of the study, analysis of the data, and preparation and review of this manuscript was supported by the Office of the Director and the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (DP2-HD-084070), by the National Institute of Allergy and Infectious Diseases through the UNC CFAR (P30-AI-50410) and the National Institutes of Health through the UNC WIHS (U01-AI-103390; see also below).; For additional funding information, see the full article.
• Keywords: pregnancy loss; women's health; epidemiology; smoking; HIV
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

OBJECTIVE:: Cigarette smoking during pregnancy increases risks of poor pregnancy outcomes including miscarriage and stillbirth (pregnancy loss), but the effect of smoking on pregnancy loss among HIV-infected women has not been explored. Here, investigated the impact of smoking on risk of pregnancy loss among HIV-positive and HIV-negative women, and estimated the potential impact of realistic smoking cessation interventions on risk of pregnancy loss among HIV-positive women. DESIGN:: We analyzed pregnancy outcomes in HIV-positive and HIV-negative participants in the Womenʼs Interagency HIV Study (WIHS) between 1994 and 2014. METHODS:: We estimated effects of current smoking at or immediately before pregnancy on pregnancy loss; we controlled for confounding using regression approaches, and estimated potential impact of realistic smoking cessation interventions using a semi-parametric g-formula approach. RESULTS:: Analysis examined 1033 pregnancies among 659 women. The effect of smoking on pregnancy loss differed dramatically by HIV status: adjusted for confounding, the risk difference comparing current smokers to current non-smokers was 19.2% (95% CL 10.9, 27.5%) in HIV-positive women and 9.7% (95% CL 0.0, 19.4%) in HIV-negative women. These results were robust to sensitivity analyses. We estimated that we would need to offer a realistic smoking cessation intervention to 36 women to prevent one pregnancy loss. CONCLUSIONS:: Smoking is a highly prevalent exposure with important consequences for pregnancy in HIV-positive pregnant women in the United States, even in the presence of potent highly active antiretroviral therapy. This evidence supports greater efforts to promote smoking cessation interventions among HIV-positive women, especially those who desire to become pregnant.