Prevalence, Correlates and Outcomes of Smoking in Pregnant Women with HIV: A National Observational Study in Italy

Abstract

Background: Few studies have evaluated in pregnant women with HIV the prevalence of smoking and its associations with maternal and neonatal outcomes. Objectives: to assess the prevalence of smoking among women with HIV in early pregnancy and the association between smoking and pregnancy outcomes in this particular population. Methods: We used data from a multicenter observational study to define the prevalence of smoking in women with HIV in early pregnancy, and the role of smoking status and intensity as risk factors for adverse maternal and neonatal outcomes. Main outcome measures were fetal growth restriction [FGR], preterm delivery [PD] and low birthweight [LB], evaluated in univariate and multivariate analyses. Results: The overall (2001–2018) prevalence of reported smoking (at least one cigarette/day) was 25.6% (792/3097), with a significant decrease in recent years (19.0% in 2013–2018). Women who smoked were less commonly African, had lower body mass index, older age, a longer history of HIV infection and higher CD4 counts. In univariate analyses, smokers were significantly more likely to have PD, LB, FGR and detectable HIV viral load at third trimester. Multivariable analyses confirmed for smokers a significantly higher risk of LB (adjusted odds ratio [AOR]: 1.69, 95%CI 1.22–2.34) and FGR (AOR 1.88, 95%CI 1.27–2.80), while the associations with detectable HIV and PD were not maintained. Conclusions: The common prevalence of smoking among pregnant women with HIV and its association with adverse outcomes indicates that smoking cessation programs in this population may have a significant impact on neonatal and maternal health.

Keywords:

• HIV
• smoking
• pregnancy
• intrauterine growth retardation
• preterm delivery
• low birthweight

Acknowledgments

We thank Cosimo Polizzi and Alessandra Mattei of the Istituto Superiore di Sanità in Rome, Italy, for providing technical secretarial for this study. We also thank Ernesto Costabile for providing assistance as documentalist. No compensation was received for these contributions.

Declaration of interest

None to declare. None of the authors has a commercial or other association, financial interest, activity, relationship or association that might pose a conflict of interest. The corresponding author had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Contribution to authorship

MF designed the study, drafted and finalized the manuscript, and was responsible for statistical analysis; MR, GM, BT, VMS, GL, MS, GS, LF, AM, AV, GG, CP, SD and ET substantially contributed to acquisition of data and critical revision of the manuscript. All the authors approved the final version to be published.

Details of ethics approval

Ethics approval was obtained from the Ethics Committee of the I.N.M.I. Lazzaro Spallanzani in Rome (ref. deliberation 578/2001, September 28, 2001).

Additional information

Funding

This work (currently not funded) was supported in the past by public research grants (ref.: H85E08000200005) from the Italian Medicines Agency (AIFA). The funder had no role in study design, data collection, data analysis, manuscript preparation and/or publication decision. No funding was received for this work from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; and the Howard Hughes Medical Institute (HHMI).