title: Cigarette smoking, premature rupture of membranes, and vertical transmission of HIV-1 among women with low CD4+ levels.
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).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, Rockville, MD 20852.
authors.forename: D N
authors.initials: DN
authors.lastname: Burns
authors.forename: S
authors.initials: S
authors.lastname: Landesman
authors.forename: L R
authors.initials: LR
authors.lastname: Muenz
authors.forename: R P
authors.initials: RP
authors.lastname: Nugent
authors.forename: J J
authors.initials: JJ
authors.lastname: Goedert
authors.forename: H
authors.initials: H
authors.lastname: Minkoff
authors.forename: J H
authors.initials: JH
authors.lastname: Walsh
authors.forename: H
authors.initials: H
authors.lastname: Mendez
authors.forename: A
authors.initials: A
authors.lastname: Rubinstein
authors.forename: A
authors.initials: A
authors.lastname: Willoughby
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D015496:CD4-Positive T-Lymphocytes; D015331:Cohort Studies; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000150:complications / Q000276:immunology; D005500:Follow-Up Studies; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000276:immunology / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000276:immunology; D015819:Substance Abuse, Intravenous / Q000150:complications
chemical_list: D015483:HIV Antibodies