A Systematic Review of Interventions to Reduce Maternal Mortality among HIV-Infected Pregnant and Postpartum Women

Abstract

Background:In high-prevalence populations, HIV-related maternal mortality is high with increased mortality found among HIV-infected pregnant and postpartum women compared to their uninfected peers. The scale-up of HIV-related treatment options and broader reach of programming for HIV-infected pregnant and postpartum women is likely to have decreased maternal mortality. This systematic review synthesized evidence on interventions that have directly reduced mortality among this population.Methods:Studies published between January 1, 2003 and November 30, 2014 were searched using PubMed. Of the 1,373 records screened, 19 were included in the analysis.Results:Interventions identified through the review include antiretroviral therapy (ART), micronutrients (multivitamins, vitamin A, and selenium), and antibiotics. ART during pregnancy was shown to reduce mortality. Timing of ART initiation, duration of treatment, HIV disease status, and ART discontinuation after pregnancy influence mortality reduction. Incident pregnancy in women already on ART for their health appears not to have adverse consequences for the mother. Multivitamin use was shown to reduce disease progression while other micronutrients and antibiotics had no beneficial effect on maternal mortality.Conclusions:ART was the only intervention identified that decreased death in HIV-infected pregnant and postpartum women. The findings support global trends in encouraging initiation of lifelong ART for all HIV-infected pregnant and breastfeeding women (Option B+), regardless of their CD4+ count, as an important step in ensuring appropriate care and treatment.Global Health Implications:Maternal mortality is a rare event that highlights challenges in measuring the impact of interventions on mortality. Developing effective patient-centered interventions to reduce maternal morbidity and mortality, as well as corresponding evaluation measures of their impact, requires further attention by policy makers, program managers, and researchers.

Trends in maternal deaths in HIV‐infected women, on a background of changing HIV management guidelines in South Africa: 1997 to 2015

“…In our study, the majority of HIV‐infected women were diagnosed during pregnancy and this points to a need to increase routine HIV testing outside of pregnancy to allow linkage to care and early initiation of ART. Preconception ART is associated with a decreased risk of HIV‐related maternal deaths .…”

Improving postpartum retention in care for women living with HIV in the United States

“…Studies of interventions to improve postpartum retention in HIV care are limited. The majority of this research has been conducted in low-resource or moderate-resource countries and often addresses uptake and adherence to perinatal prevention interventions in addition to postpartum retention in care [ 5 , 6 ]. In a recent review of these topics in relation to pregnant and postpartum women initiating antiretroviral therapy (ART) in sub-Saharan Africa, Myer et al [ 4 ] examine key issues related to adherence and retention and emphasize the need for additional understanding and innovative interventions.…”

Vitamin A Requirements in Pregnancy and Lactation

“…A 2015 Cochrane systematic review of maternal and newborn health outcomes after VAS in pregnancy concluded that in pregnant women living with HIV, antenatal VAS reduces the risk of maternal anemia and night blindness ( 99 ). Two RCTs highlighted in another systematic review ( 193 ) provided antenatal VAS to pregnant women living with HIV, and found that VA either had no significant protective effect against maternal mortality ( 194 ) or reduced the benefits observed when added to a multivitamin regimen ( 195 ).…”