Placental growth disorders and perinatal adverse outcomes in Brazilian HIV-infected pregnant women

Abstract

Fetal and placental growth disorders are common in maternal human immunodeficiency virus (HIV) infection and can be attributed to both the infection and comorbidities not associated with HIV. We describe placental growth disorders and adverse reproductive outcomes in HIV-infected pregnant women whose delivery occurred between 2001-2014 in Vitoria, Brazil. Cases with gestational age (GA) � than 22 weeks validated by ultrasonography, with placental and fetal weight dimensions at birth, were studied. Outcomes were summarized as proportions of small (SGA), appropriate (AGA), and large (LGA) for GA when the z-score values were below-1.28, between-1.28 and +1.28, or above +1.28, respectively. Of 187 fetal attachment requisitions, 122(65.2%) women and their newborns participated in the study. The median maternal age was 28 years and 81(66.4%) underwent � 6 prenatal visits. A total of 81(66.4%) were diagnosed before current pregnancy; 68(55.7%) exhibited criteria for acquired immunodeficiency syndrome (AIDS); 64(52.4%) had detectable viral load; 25 (20.5%) cases presented SGA placental weight and 6(4.9%) SGA placental thickness. SGA placental area was observed in 41(33.6%) cases, and among the SGA placental weight cases 12(48%) were also SGA fetal weight. Preterm birth (PTB) occurred in 15.6%(19/122) of cases; perinatal death in 4.1%(5/122) and HIV vertical transmission in 6 of 122 (4.9%). Women, �36 years old, were 5.7 times more likely to have PTB than those under 36. Also, patients with AIDS-defining criteria were 3.7 times more likely to have PTB. Prenatal care was inversely associated with PTB. Statistically significant associations were observed between AGA placental area and Protease Inhibitor usage and between SGA placental weight and SGA area. We found a prevalence of placental growth disorders in HIV-infected pregnant women and values higher than international reference values. The restriction of placental growth was a common disorder, possibly attributed to virus effects or a combination of antiretroviral regimens.

Adverse Pregnancy Outcomes Among HIV-positive Women in the Era of Universal Antiretroviral Therapy Remain Elevated Compared With HIV-negative Women

“…One study evaluated the prevalence of placental growth disorders in HIV-positive pregnant women on ART, reporting a higher prevalence of such disorders compared with international reference values, noting that restriction of placental growth was most common. 36 Another study has suggested that altered angiogenesis may be a mechanism underlying adverse outcomes in women with HIV receiving ART. 37 We noted that the timing of ART initiation did not have any influence on the occurrence of adverse events.…”

Relationship between Maternal Vitamin D Levels and Adverse Outcomes

“…Hence, the placenta has several functions, such as metabolism, nutrition, and barrier protection, in terms of embryonic development. Impairment of placental function may lead to miscarriage, preterm delivery, and stillbirth [ 149 , 150 ].…”

Antiretroviral Drugs Impact Autophagy with Toxic Outcomes

“…PI effects on autophagy in placental cells may disrupt normal placental development and function. PI use during pregnancy has been variably associated with premature delivery, low birth weight, small for gestational age, maternal and neonatal endocrine dysfunction, and neonatal hematologic abnormalities [44][45][46][47][48][49] as well as abnormal placental morphology, cord insertion, and vasculature [48,[50][51][52]. ER stress underlies many toxicities associated with PI, and ER stress is important to the physiology and pathophysiology of the placenta [53].…”