Correlates and outcomes of preterm birth, low birth weight, and small for gestational age in HIV-exposed uninfected infants

Abstract

BackgroundPreterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA) contribute to neonatal mortality. Maternal HIV-1 infection has been associated with an increased risk of PTB, but mechanisms underlying this association are undefined. We describe correlates and outcomes of PTB, LBW, and SGA in HIV-exposed uninfected infants.MethodsThis was a retrospective analysis of cohort study. Between 1999–2002, pregnant, HIV-infected women were enrolled into an HIV-1 transmission study. Logistic regression was used to identify correlates of PTB, LBW and SGA in HIV-negative, spontaneous singleton deliveries. Associations between birth outcomes and mortality were measured using survival analyses.ResultsIn multivariable models, maternal plasma (OR = 2.1, 95% CI = 1.1-3.8) and cervical HIV-1 RNA levels (OR = 1.6, 95% CI = 1.1-2.4), and CD4 < 15% (OR = 2.4, 95% CI = 1.0-5.6) were associated with increased odds of PTB. Abnormal vaginal discharge and cervical polymorphonuclear leukocytes were also associated with PTB. Cervical HIV-1 RNA level (OR = 2.4, 95% CI = 1.5-6.7) was associated with an increased odds of LBW, while increasing parity (OR = 0.46, 95% CI = 0.24-0.88) was associated with reduced odds. Higher maternal body mass index (OR = 0.75, 95% CI = 0.61-0.92) was associated with a reduced odds of SGA, while bacterial vaginosis was associated with >3-fold increased odds (OR = 3.2, 95% CI = 1.4-7.4). PTB, LBW, and SGA were each associated with a >6-fold increased risk of neonatal death, and a >2-fold increased rate of infant mortality within the first year.ConclusionsMaternal plasma and cervical HIV-1 RNA load, and genital infections may be important risk factors for PTB in HIV-exposed uninfected infants. PTB, LBW, and SGA are associated with increased neonatal and infant mortality in HIV-exposed uninfected infants.

Impact of Birth HIV-PCR Testing on the Uptake of Follow-up Early Infant Diagnosis Services in Cape Town, South Africa

“…However, infants diagnosed at birth were more likely to achieve viral suppression at 6 months than infants diagnosed from routine EID testing. The lower levels in overall linkage to care could be explained by survival bias; infants infected in utero are at higher risk of rapid disease progression, and infants born preterm or with a LBW were more likely to receive an HIV-PCR test at birth but have 6 fold increased risk of neonatal mortality (26,27). Infected infants may therefore have died before possible linkage to care could occur.…”

The developmental effects of HIV and alcohol: a comparison of gestational outcomes among babies from South African communities with high prevalence of HIV and alcohol use

“…Several meta-analyses indicate that heavy alcohol use during pregnancy can increase risk for low birth weight, preterm birth, small gestational age [18] and long term growth impact including gross motor deficits [19]. Similarly, maternal HIV infection has been associated with poor fetal outcomes including low birth weight [20] and pre-term delivery [21, 22]. Maternal HIV infection, particularly mother-to-child transmission of HIV, can affect fetal development of the infant brain.…”

Maternal, Obstetric, and Infant Factors and Their Association with the Risk of HIV Infection in Infants at Dr. Moewardi Hospital, Surakarta

“…Infeksi vaginosis bakteri meningkatan 3 kali lipat terjadinya kecil masa kehamilan. Kecil masa kehamilan berhubungan dengan peningkatan 6 kali lipat terjadinya infeksi HIV bayi yang dapat menyebabkan kematian (Slyker et al, 2014).…”

“…Menurut Slyker et al, (2014) Tingkat HIV-1RNA ibu hamil berhubungan dengan peningkatan kejadian BBLR. Bayi yang mengalami BBLR meningkat 6 kali terjadi infeksi HIV.…”