Estimated blood pressure trajectories and hypertension patterns among pregnant women living with HIV, Haiti, 2007–2017

Abstract

Hypertension in pregnancy is a key driver of mortality and morbidity among Haitian women. HIV infection and treatment may worsen hypertension and increase cardiovascular disease risk. The authors examined blood pressure and hypertension patterns among 1965 women (2306 pregnancies ending in live births) in a prevention of maternal‐to‐child transmission (PMTCT) program in Port‐au‐Prince, Haiti, between 2007 and 2017. Hypertension was defined as blood pressure ≥140/90 mm Hg on two consecutive visits. Latent class analysis assessed trajectories of mean arterial pressure (MAP) and multinomial ordinal logistic regression examined factors associated with higher trajectories. Between 2007–2009 and 2013–2016, hypertension at PMTCT entry increased from 1.3% to 3.8% (p = .005), while incidence at any time during PMTCT follow‐up increased from 5.0 to 16.1 per 100 person‐years (p < .001). Hypertension detected ≤20 weeks and > 20 weeks of gestation (possible gestational hypertension) increased from 1.1% to 3.5% (p = .003) and from 2.3% to 6.9% (p < .001), respectively. Five MAP trajectories ranged from low‐stable to high‐increasing. In multivariable analysis controlling for history of antiretroviral therapy, age, parity, and weight, program entry in more recent years was associated with greater odds of higher MAP trajectory (adjusted odds ratio for 2013–2016 vs. 2007–2009 = 3.1, 95% confidence interval: 1.7–5.6). The increasing prevalence and incidence of hypertension highlight a need for screening and management prior to PMTCT entry and during follow‐up. In a population with limited access to chronic disease care, and where many deliveries occur outside of a clinical setting, the period of PMTCT follow‐up represents an opportunity to diagnose and initiate management of preexisting and pregnancy‐related hypertension.

Small for Gestational Age Newborns in French Guiana: The Importance of Health Insurance for Prevention

“…While young age [1] and poor prenatal care [43] have already been associated with SGA newborns, lack of information on certain confounding factors may hamper the significance of our results regarding mothers from Haiti or Guyana. It is likely that mothers born from Haiti may have more pregnancy complications such as pre-eclampsia for instance [44,45], that could partly explain our results. For mothers born in Guyana, pregnancy-related complications may also explain these results, although literature is very scarce for this population.…”

A Systematic Review on Cardiometabolic Risks and Perinatal Outcomes among Pregnant Women Living with HIV in the Era of Antiretroviral Therapy

“…Therefore, 201 full texts were retrieved and subjected to screening, from which nine were excluded as they were research protocols, one was retracted from a journal, 45 did not include pregnant HIV women, seven were not on HIV, 34 were not on ART, and 74 did not report any outcome of interest, such as any outcome of perinatal or marker of CMR. Only 31 clinical studies [ 12 , 26 , 33 , 36 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ] conducted on 20,904 HIV women on ART before or during pregnancy were found relevant based on our eligibility criteria ( Figure 1 ). These clinical studies were published in peer-reviewed journals between 1999 and 2023.…”

“…These clinical studies were published in peer-reviewed journals between 1999 and 2023. The publications were from Southern Africa (South Africa [ 45 , 52 , 69 ] and Botswana [ 66 ], Eastern Africa (Ethiopia [ 36 ], Tanzania [ 69 ], Kenya [ 64 ], Uganda [ 60 , 62 , 69 ], Mozambique [ 33 , 61 ], Malawi [ 69 ], Zambia [ 52 , 69 ], and Zimbabwe [ 69 ]), Southern Europe (Spain [ 46 , 47 ]), Northern Europe (United Kingdom [ 55 ]) and Western Europe (Netherlands [ 12 , 57 ]), Eastern Asia (China [ 26 , 67 ]), Southern Asia (India [ 69 ] and Thailand [ 49 ]), Southern America (Brazil [ 43 , 50 , 51 , 56 ]) and Northern America (Canada [ 60 ] and USA [ 44 , 48 , 53 , 54 , 58 , 59 , 60 , 63 , 65 , 68 ]). The characteristics of included studies are presented in Table 1 .…”

“…Cardiometabolic risk factors increase the risk of developing cardiovascular diseases, especially in HIV patients on protease inhibitors-based ART, such as ritonavir and lopinavir, and NNRTI-based ART such as efavirenz [ 70 ]. Evidence showed that pWLWH had an increased risk of developing hypertension, especially at ≤ or greater than 20 weeks of gestation [ 44 ]. Dyslipidemia was also significant in HIV women on ART compared to PMTCT during antenatal care [ 49 ].…”