Predictors of adverse pregnancy outcomes in women infected with <scp>HIV</scp> in <scp>L</scp>atin <scp>A</scp>merica and the <scp>C</scp>aribbean: a cohort study

Kreitchmann, Régis; Li, SX; Melo, VH; Coelho, Débora Fernandes; Watts, D. Heather; Joao, E; Coutinho, Conrado Milani; Alarcon, JO; Gk, Siberry

doi:10.1111/1471-0528.12680

Cited by 31 publications

(27 citation statements)

References 43 publications

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“…We suspect that these hospitalizations were, in part, the result of complications associated with poor birth outcomes at index pregnancy (i.e., stillbirth, abortions), but given that both hospitalization and birth outcomes contributed independently to the final model, other factors may also be at play. Previously, we’ve shown that hospitalization during pregnancy was associated with adverse pregnancy outcomes, including preterm delivery, small for gestational age, low birth weight, and neonatal death (Kreitchmann et al, 2014). …”

Section: Discussionmentioning

confidence: 99%

“…Advances in the prevention of mother-to-child transmission and improvements in HIV treatment outcomes are also likely to have an influence on the reproductive choices of women living with HIV, including decisions about number of pregnancies (Gange et al, 2002; Marcellin et al, 2010; Read et al, 2007). For women with HIV infection, the high risk of adverse pregnancy outcomes, including preterm deliveries, low birth weight, small for gestational age, stillbirths and neonatal deaths, may also affect their decisions about subsequent pregnancies (Ekouevi et al, 2008; Kreitchmann et al, 2014; Kupka et al, 2009; Young et al, 2012). …”

Section: Introductionmentioning

confidence: 99%

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Repeat pregnancy in women with HIV infection in Latin America and the Caribbean

et al. 2015

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Intended and unintended pregnancies occur frequently among HIV-infected women. We evaluated the occurrence of repeat pregnancy and characteristics associated with this outcome among HIV-infected women in Latin America and the Caribbean who were participating in the National Institute of Child Health and Human Development (NICHD) International Site Development Initiative (NISDI). Of the 1342 HIV-infected pregnant women enrolled in NISDI, 124 (9.2%) had one or more repeat pregnancies on study. Median time between the index delivery and date of conception of the subsequent pregnancy was 1.4 years (range 0.1–5.7). Younger age [odds ratio (OR)=1.07, 95% confidence interval (CI): 1.04–1.11 per one-year decrease in age], hospitalization during the index pregnancy or up to 6 months postpartum [OR=2.0, 95% CI: 1.2–3.4], and poor index pregnancy outcome (stillbirth or spontaneous/therapeutic abortion) [OR=3.4, 95% CI: 1.4–8.4] were associated with increased occurrence of repeat pregnancy in multivariable analysis. Among women with repeat pregnancies, the proportion receiving antiretroviral treatment (versus prophylaxis) increased from 39.4% at the time of the index pregnancy to 81.8% at the time of the repeat pregnancy (p<0.001). These results can help identify women most likely to benefit from reproductive counseling in order to assist with healthy pregnancy planning and prevention of unintended pregnancies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Repeat pregnancy in women with HIV infection in Latin America and the Caribbean

et al. 2015

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“…A recent report demonstrated increased morbidity among infants of HIV-positive smokers compared with those of HIV-positive nonsmokers, but this study did not examine miscarriage[2] nor did a study which found positive associations between smoking and adverse birth outcomes. [25]…”

Section: Introductionmentioning

confidence: 99%

Smoking, HIV, and risk of pregnancy loss

Westreich

Cates

Cohen

et al. 2017

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Objective:Cigarette smoking during pregnancy increases risks of poor pregnancy outcomes including miscarriage and stillbirth (pregnancy loss), but the effect of smoking on pregnancy loss among HIV-infected women has not been explored. Here, investigated the impact of smoking on risk of pregnancy loss among HIV-positive and HIV-negative women, and estimated the potential impact of realistic smoking cessation interventions on risk of pregnancy loss among HIV-positive women.Design:We analyzed pregnancy outcomes in HIV-positive and HIV-negative participants in the Women's Interagency HIV Study between 1994 and 2014.Methods:We estimated effects of current smoking at or immediately before pregnancy on pregnancy loss; we controlled for confounding using regression approaches, and estimated potential impact of realistic smoking cessation interventions using a semiparametric g-formula approach.Results:Analysis examined 1033 pregnancies among 659 women. The effect of smoking on pregnancy loss differed dramatically by HIV status: adjusted for confounding, the risk difference comparing current smokers to current nonsmokers was 19.2% (95% confidence limit 10.9–27.5%) in HIV-positive women and 9.7% (95% confidence limit 0.0–19.4%) in HIV-negative women. These results were robust to sensitivity analyses. We estimated that we would need to offer a realistic smoking cessation intervention to 36 women to prevent one pregnancy loss.Conclusion:Smoking is a highly prevalent exposure with important consequences for pregnancy in HIV-positive pregnant women in the United States, even in the presence of potent highly active antiretroviral therapy. This evidence supports greater efforts to promote smoking cessation interventions among HIV-positive women, especially those who desire to become pregnant.

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“…Such findings are difficult to interpret, given the limited information and the variable rates of intrauterine death reported in the general population of women with HIV. Early studies, conducted in a context of high maternal viral load/low CD4 cell count and no use of HAART, had shown high rates (11%), but more recent studies have shown much lower rates (1.9%) . Advanced maternal disease or high plasma viral load may represent significant predictors of this outcome and explain the above differences …”

Section: Discussionmentioning

confidence: 99%