title: Smoking, HIV, and risk of pregnancy loss.
abstract: 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.
  
  
  
  We analyzed pregnancy outcomes in HIV-positive and HIV-negative participants in the Women's Interagency HIV Study between 1994 and 2014.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: aDepartment of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina bDepartment of Medicine, John H. Stroger, Jr. Hospital of Cook County and Rush Medical College cHektoen Institute of Medicine/The CORE Center, Cook County Health & Hospital Systems, Chicago, Illinois dDepartment of Obstetrics, Gynecology & Reproductive Health Services, University of California San Francisco, San Francisco, California eDepartment of Psychiatry and Behavior Neurobiology, University of Alabama Birmingham, Birmingham, Alabama fAlbert Einstein College of Medicine, Montefiore Medical Center, New York, New York gDepartment of Preventive Medicine, University of Southern California, Los Angeles, California hDivision of Infectious Diseases, Georgetown University, Washington, District of Columbia iDepartment of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia jState University of New York Downstate Medical Center, Brooklyn, New York kDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland lDivision of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida mDepartment of Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Westreich
authors.forename: Jordan
authors.initials: J
authors.lastname: Cates
authors.forename: Mardge
authors.initials: M
authors.lastname: Cohen
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Weber
authors.forename: Dominika
authors.initials: D
authors.lastname: Seidman
authors.forename: Karen
authors.initials: K
authors.lastname: Cropsey
authors.forename: Rodney
authors.initials: R
authors.lastname: Wright
authors.forename: Joel
authors.initials: J
authors.lastname: Milam
authors.forename: Mary A
authors.initials: MA
authors.lastname: Young
authors.forename: C Christina
authors.initials: CC
authors.lastname: Mehta
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Gustafson
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Golub
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Fischl
authors.forename: Adaora A
authors.initials: AA
authors.lastname: Adimora
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology*; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011446:Prospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects*; D014481:United States