About this item:

235 Views | 273 Downloads

Author Notes:

Correspondence to Daniel Westreich, Department of Epidemiology, CB 7435 McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA. Tel: +1 919 966 7437; e-mail: djw@unc.edu

The authors thank Dr Stephen R. Cole, PhD (Department of Epidemiology, UNC-Chapel Hill) for input on this work.

[For contributions full list, please refer to the full article]


Research Funding:

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.


  • epidemiology
  • HIV
  • pregnancy loss
  • smoking
  • women's health

Smoking, HIV, and risk of pregnancy loss

Show all authors Show less authors


Journal Title:



Volume 31, Number 4


, Pages 553-560

Type of Work:

Article | Final Publisher PDF


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.

Copyright information:

Copyright © 2016 Wolters Kluwer Health, Inc.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Creative Commons License

Export to EndNote