Smoking, HIV, and risk of pregnancy loss

Daniel Westreich, Jordan Cates, Mardge Cohen, Kathleen M. Weber, Dominika Seidman, Karen Cropsey, Rodney Wright, Joel Milam, Mary A. Young, C. Christina Mehta, Deborah R. Gustafson, Elizabeth Golub, Margaret A. Fischl, Adaora A. Adimora

Research output: Contribution to journalArticle

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 Women's Interagency HIV Study 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 semiparametric 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 nonsmokers was 19.2% (95% confidence limit 10.9-27.5%) in HIV-positive women and 9.7% (95% confidence limit 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)553-560
Number of pages8
JournalAIDS
Volume31
Issue number4
DOIs
StatePublished - Feb 20 2017

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Smoking
HIV
Pregnancy
Smoking Cessation
Pregnancy Outcome
Stillbirth
Highly Active Antiretroviral Therapy
Spontaneous Abortion
Pregnant Women

Keywords

  • Epidemiology
  • HIV
  • Pregnancy loss
  • Smoking
  • Women's health

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Westreich, D., Cates, J., Cohen, M., Weber, K. M., Seidman, D., Cropsey, K., ... Adimora, A. A. (2017). Smoking, HIV, and risk of pregnancy loss. AIDS, 31(4), 553-560. https://doi.org/10.1097/QAD.0000000000001342

Smoking, HIV, and risk of pregnancy loss. / Westreich, Daniel; Cates, Jordan; Cohen, Mardge; Weber, Kathleen M.; Seidman, Dominika; Cropsey, Karen; Wright, Rodney; Milam, Joel; Young, Mary A.; Mehta, C. Christina; Gustafson, Deborah R.; Golub, Elizabeth; Fischl, Margaret A.; Adimora, Adaora A.

In: AIDS, Vol. 31, No. 4, 20.02.2017, p. 553-560.

Research output: Contribution to journalArticle

Westreich, D, Cates, J, Cohen, M, Weber, KM, Seidman, D, Cropsey, K, Wright, R, Milam, J, Young, MA, Mehta, CC, Gustafson, DR, Golub, E, Fischl, MA & Adimora, AA 2017, 'Smoking, HIV, and risk of pregnancy loss', AIDS, vol. 31, no. 4, pp. 553-560. https://doi.org/10.1097/QAD.0000000000001342
Westreich D, Cates J, Cohen M, Weber KM, Seidman D, Cropsey K et al. Smoking, HIV, and risk of pregnancy loss. AIDS. 2017 Feb 20;31(4):553-560. https://doi.org/10.1097/QAD.0000000000001342
Westreich, Daniel ; Cates, Jordan ; Cohen, Mardge ; Weber, Kathleen M. ; Seidman, Dominika ; Cropsey, Karen ; Wright, Rodney ; Milam, Joel ; Young, Mary A. ; Mehta, C. Christina ; Gustafson, Deborah R. ; Golub, Elizabeth ; Fischl, Margaret A. ; Adimora, Adaora A. / Smoking, HIV, and risk of pregnancy loss. In: AIDS. 2017 ; Vol. 31, No. 4. pp. 553-560.
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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 Women's Interagency HIV Study 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 semiparametric 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 nonsmokers was 19.2{\%} (95{\%} confidence limit 10.9-27.5{\%}) in HIV-positive women and 9.7{\%} (95{\%} confidence limit 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. Conclusion: 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.",
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AU - Cates, Jordan

AU - Cohen, Mardge

AU - Weber, Kathleen M.

AU - Seidman, Dominika

AU - Cropsey, Karen

AU - Wright, Rodney

AU - Milam, Joel

AU - Young, Mary A.

AU - Mehta, C. Christina

AU - Gustafson, Deborah R.

AU - Golub, Elizabeth

AU - Fischl, Margaret A.

AU - Adimora, Adaora A.

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N2 - 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 Women's Interagency HIV Study 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 semiparametric 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 nonsmokers was 19.2% (95% confidence limit 10.9-27.5%) in HIV-positive women and 9.7% (95% confidence limit 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. Conclusion: 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.

AB - 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 Women's Interagency HIV Study 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 semiparametric 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 nonsmokers was 19.2% (95% confidence limit 10.9-27.5%) in HIV-positive women and 9.7% (95% confidence limit 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. Conclusion: 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.

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KW - HIV

KW - Pregnancy loss

KW - Smoking

KW - Women's health

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