Cigarette smoking, premature rupture of membranes, and vertical transmission of HIV-1 among women with low CD4+ levels

David N. Burns, Sheldon Landesman, Larry R. Muenz, Robert P. Nugent, James J. Goedert, Howard Minkoff, Judith H. Walsh, Hermann Mendez, Arye Rubinstein, Anne Willoughby

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Abstract

To examine the possible influence of obstetric factors, substance use during pregnancy, and other maternal factors on the relationship between a low maternal CD4+ level and vertical transmission of human immunodeficiency virus type 1 (HIV-1), data were analyzed from the Mothers and Infants Cohort Study, a prospective cohort followed for up to 4 years between 1986 and 1992 in Brooklyn and the Bronx, New York. The overall transmission rate for the cohort was 25.1% (95% confidence interval (CI) = 19.0-31.3). Prenatal CD4+ lymphocyte measurements were available for 162 HIV-seropositive mothers of infants with known infection outcomes. Among mothers who smoked cigarettes after the first trimester, those whose mean prenatal CD4+ level was <20% had more than a threefold increased risk of transmitting their infection to their infants [relative risk (RR) = 3.30; 95% CI = 1.46-7.44; p = 0.004). Among mothers who developed premature rupture of membranes, those with a low CD4+ level had a similarly increased risk of vertical transmission (RR = 4.33; 95% CI = 1.78-10.5; p = 0.003). These relative risks were much higher than those for mothers who did not smoke after the first trimester (RR = 1.14; 95% CI = 0.48-2.70; p = 0.76) or have premature rupture of membranes (RR = 1.29; 95% CI = 0.61-2.74; p = 0.50), indicating that these factors modified the effect of CD4+ level on transmission. Among all mothers without regard to CD4+ level, those who experienced preterm premature rupture of membranes were also at greater risk of transmission (RR = 2.24; 95% CI = 1.07-4.69; p = 0.03). These findings suggest that it may be possible to decrease the risk of vertical transmission of HIV-1 among women with low CD4+ levels by discontinuation of smoking during pregnancy and other interventions that reduce the risk of premature rupture of membranes.

Original languageEnglish (US)
Pages (from-to)718-726
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Volume7
Issue number7
Publication statusPublished - Jul 1994

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Keywords

  • HIV infection
  • Premature rupture of fetal membranes
  • Smoking

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Burns, D. N., Landesman, S., Muenz, L. R., Nugent, R. P., Goedert, J. J., Minkoff, H., ... Willoughby, A. (1994). Cigarette smoking, premature rupture of membranes, and vertical transmission of HIV-1 among women with low CD4+ levels. Journal of Acquired Immune Deficiency Syndromes, 7(7), 718-726.