Bj. Turner et al., CIGARETTE-SMOKING AND MATERNAL-CHILD HIV TRANSMISSION, Journal of acquired immune deficiency syndromes and human retrovirology, 14(4), 1997, pp. 327-337
We investigated the association of cigarette smoking with maternal-chi
ld HIV transmission, adjusting for illicit drug use, maternal clinical
status, and delivery factors. Vital statistics birth data were linked
to the New York State Medicaid HIV/AIDS Research Database for HIV-inf
ected women delivering a liveborn singleton from 1988 through 1990. Fo
llow-up of these children was accomplished by Medicaid data greater th
an or equal to 2 years after birth, and their HIV status was ascertain
ed by a clinically based classification. The adjusted relative risk or
hazard (RH) of transmission for maternal factors was determined from
Cox models. The overall transmission was 24.5% for the 901 maternal-ch
ild pairs. Smokers comprised 40% of women with data on smoking (n = 76
8); their transmission rate was 31% versus 22% for nonsmokers (p = 0.0
2). In the entire cohort, the adjusted RH of transmission for smokers
was 1.45 (95% confidence interval [CI] 1.07-1.96); among women with ad
vanced HIV, the adjusted RH was even higher (RH = 1.71; 95% CI 1.14-2.
58). Users of cocaine (15% of the cohort) or of mixed or unspecified i
llicit drugs (28%) had higher transmission rates in unadjusted analysi
s (33%, p = 0.06 and 31%, p = 0.06 respectively); after adjustment for
smoking and other maternal factors, neither cocaine (RH = 1.04 (95% C
I 0.66-1.63)) nor mixed nor unspecified drug use (RH = 1.13 (95% CI =
0.75-1.70)) was significantly associated with transmission. Our data d
ocument an association of cigarette smoking during pregnancy with an i
ncreased risk of maternal-child HIV transmission that can be added to
the growing list of complications caused by cigarette smoking.