Incidence of and socio-biologic risk factors for spontaneous preterm birth in HIV positive Nigerian women

Abstract

BackgroundRecent studies have identified HIV as a leading contributor to preterm delivery and its associated morbidity and mortality. However little or no information exists in our sub-region on this subject. Identifying the factors associated with preterm delivery in HIV positive women in our country and sub-region will not only prevent mother to child transmission of HIV virus but will also reduce the morbidity and mortality associated with prematurity and low birth weight. This study was designed to determine the incidence and risk factors for preterm delivery in HIV positive Nigerians.MethodThe required data for this retrospective study was extracted from the data base of a cohort study of the outcome of prevention of mother to child transmission at the Nigerian Institute of Medical Research, Lagos. Only data of women that met the eligibility of spontaneous delivery after 20 weeks of gestation were included. Ethical approval was obtained from the Institution’s Ethical Review Board.Results181 women out of the 1626 eligible for inclusion into the study had spontaneous preterm delivery (11.1%). The mean birth weight was 3.1 ± 0.4 kg, with 10.3% having LBW. Spontaneous preterm delivery was found to be significantly associated with unmarried status (cOR: 1.7;1.52-2.57), baseline CD4 count <200 cells/mm3(cOR: 1.8; 1.16-2.99), presence of opportunistic infection at delivery (cOR: 2.2;1.23-3.57), multiple pregnancy (cOR 10.4; 4.24 – 26.17), use of PI based triple ARV therapy (eOR 10.2; 5.52 – 18.8) in the first trimester (cOR 2.5; 1.77 – 3.52) on univariate analysis. However after multivariate analysis controlling for potential confounding variables including low birth weight, only multiple pregnancy (aOR: 8.6; CI: 6.73 – 12.9), presence of opportunistic infection at delivery (aOR: 1.9; CI: 1.1 – 5.7), and 1st trimester exposure to PI based triple therapy (aOR: 5.4; CI: 3.4 – 7.8) retained their significant association with preterm delivery.ConclusionThe spontaneous preterm delivery rate among our cohort was 11.1%. HIV positive women with multiple pregnancies, symptomatic HIV infection at delivery and first trimester fetal exposure to PI based triple therapy were found to be at risk of spontaneous preterm delivery. Early booking and non-use of PI based triple therapy in the first trimester will significantly reduce the risk of preterm delivery.

Preterm births in a resource constrained setting: sociobiologic risk factors and perinatal outcomes

“…Low socioeconomic class and level of education did not show significant statistical relationship to preterm births. These findings compare favorably with previous studies 4,26 but vary from the report of Ezechi 5 and Omole-Ohonsi 6 where education and socioeconomic class showed significant association with preterm delivery. The decision to seek for healthcare including obstetric care is believed to be easier for the more educated patient and patients in the higher socioeconomic cadre.…”

“…The reported incidence of preterm birth varies between 5.8% and 11.1% in Nigeria. [3][4][5][6] Preterm birth is the leading cause of perinatal morbidity and mortality worldwide. 7 Despite the fact that global perinatal mortality rates have been on the decline in the last decade, the decline is less prominent in sub-Saharan Africa.…”

“…Identified risk factors include low socioeconomic status, HIV in pregnancy, previous preterm delivery, infections and infestations, polyhydramnios, multiple pregnancies, prelabour rupture of membranes and antepartum haemorrhage. [3][4][5][6]15 A significant proportion of preterm births are unexplained. 16 Attempts made to reduce preterm births are critical in reducing perinatal mortality.…”

Factors associated with delivering premature and/or low birth weight infants among pregnant HIV-positive women on antiretroviral treatment at Dr George Mukhari Hospital, South Africa

“…17 It is worth noting that, in our study, HIV-positive women not on ART or ARV prophylaxis significantly delivered babies with birthweight < 1 000 g. The findings in our study could be due to the fact that the HIV-positive mothers not on ART might have had a lower CD4 cell count and higher HIV RNA viral load, which might have contributed to extremely LBW (< 1 000 g) babies. 18 In our study, 35% of the HIV-positive pregnant women delivered preterm babies, which is higher than the 11% reported in Nigeria 19,20 and 25% in India. 16 The reason for the high premature birth rate in our study is unclear, but it could be related to young age, low education levels, no or low pregnancy weight gain and HIV disease stage 2 or more.…”

Incidence and Fetal Outcomes of HIV/Aids Patients at Hasan Sadikin General Hospital

“…OALib Journal were preterm delivery rate [18]. Another previous study from US in 1990's found that 19% infants born to HIV-infected mothers were premature [19].…”