Smoking, HIV, and risk of pregnancy loss

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

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish (US)
JournalAIDS
DOIs
StateAccepted/In press - Nov 29 2016

Fingerprint

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

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. (Accepted/In press). Smoking, HIV, and risk of pregnancy loss. AIDS. 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 L.; Milam, Joel; Young, Mary A.; Mehta, Christina C.; Gustafson, Deborah R.; Fischl, Margaret A.; Adimora, Adaora A.

In: AIDS, 29.11.2016.

Research output: Contribution to journalArticle

Westreich, D, Cates, J, Cohen, M, Weber, KM, Seidman, D, Cropsey, K, Wright, RL, Milam, J, Young, MA, Mehta, CC, Gustafson, DR, Fischl, MA & Adimora, AA 2016, 'Smoking, HIV, and risk of pregnancy loss', AIDS. 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. 2016 Nov 29. https://doi.org/10.1097/QAD.0000000000001342
Westreich, Daniel ; Cates, Jordan ; Cohen, Mardge ; Weber, Kathleen M. ; Seidman, Dominika ; Cropsey, Karen ; Wright, Rodney L. ; Milam, Joel ; Young, Mary A. ; Mehta, Christina C. ; Gustafson, Deborah R. ; Fischl, Margaret A. ; Adimora, Adaora A. / Smoking, HIV, and risk of pregnancy loss. In: AIDS. 2016.
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title = "Smoking, HIV, and risk of pregnancy loss",
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.",
author = "Daniel Westreich and Jordan Cates and Mardge Cohen and Weber, {Kathleen M.} and Dominika Seidman and Karen Cropsey and Wright, {Rodney L.} and Joel Milam and Young, {Mary A.} and Mehta, {Christina C.} and Gustafson, {Deborah R.} and Fischl, {Margaret A.} and Adimora, {Adaora A.}",
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AU - Westreich, Daniel

AU - Cates, Jordan

AU - Cohen, Mardge

AU - Weber, Kathleen M.

AU - Seidman, Dominika

AU - Cropsey, Karen

AU - Wright, Rodney L.

AU - Milam, Joel

AU - Young, Mary A.

AU - Mehta, Christina C.

AU - Gustafson, Deborah R.

AU - Fischl, Margaret A.

AU - Adimora, Adaora A.

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Y1 - 2016/11/29

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 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.

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 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.

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