Pregnancy loss and role of infant HIV status on perinatal mortality among HIV-infected women

Abstract

BackgroundHIV-infected women, particularly those with advanced disease, may have higher rates of pregnancy loss (miscarriage and stillbirth) and neonatal mortality than uninfected women. Here we examine risk factors for these adverse pregnancy outcomes in a cohort of HIV-infected women in Zambia considering the impact of infant HIV status.MethodsA total of 1229 HIV-infected pregnant women were enrolled (2001–2004) in Lusaka, Zambia and followed to pregnancy outcome. Live-born infants were tested for HIV by PCR at birth, 1 week and 5 weeks. Obstetric and neonatal data were collected after delivery and the rates of neonatal (<28 days) and early mortality (<70 days) were described using Kaplan-Meier methods.ResultsThe ratio of miscarriage and stillbirth per 100 live-births were 3.1 and 2.6, respectively. Higher maternal plasma viral load (adjusted odds ratio [AOR] for each log10 increase in HIV RNA copies/ml = 1.90; 95% confidence interval [CI] 1.10–3.27) and being symptomatic were associated with an increased risk of stillbirth (AOR = 3.19; 95% CI 1.46–6.97), and decreasing maternal CD4 count by 100 cells/mm3 with an increased risk of miscarriage (OR = 1.25; 95% CI 1.02–1.54). The neonatal mortality rate was 4.3 per 100 increasing to 6.3 by 70 days. Intrauterine HIV infection was not associated with neonatal morality but became associated with mortality through 70 days (adjusted hazard ratio = 2.76; 95% CI 1.25–6.08). Low birth weight and cessation of breastfeeding were significant risk factors for both neonatal and early mortality independent of infant HIV infection.ConclusionsMore advanced maternal HIV disease was associated with adverse pregnancy outcomes. Excess neonatal mortality in HIV-infected women was not primarily explained by infant HIV infection but was strongly associated with low birth weight and prematurity. Intrauterine HIV infection contributed to mortality as early as 70 days of infant age. Interventions to improve pregnancy outcomes for HIV-infected women are needed to complement necessary therapeutic and prophylactic antiretroviral interventions.

Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-infected Pregnant Women and Adverse Infant Outcomes

“…(31, 32, 35-37) (38-42) Existing research on HIV-exposed infants has suggested that HIV exposure alone may be a risk factor for other infections, particularly in infants born to women with advanced HIV infection, due to genital colonization of pathogens, subclinical chorioamnionitis, and lower protective antibody titers resulting in decreased transfer of passive immunity across the placenta. (43) However, while our infant cohort appeared to be at risk for adverse outcomes from HIV-exposure at baseline, we still found that infants born to CT and/or NG-infected mothers were more likely to have an adverse outcome, irrespective of infant HIV-infection.…”

Prenatal testing and prevalence of HIV infection during pregnancy: data from the “Birth in Brazil” study, a national hospital-based study

“…This exclusion may have introduced bias in the estimated prevalence of HIV infection in pregnancy if women with miscarriages tend to have an increased likelihood of HIV infection [50,51]. …”

Predictors of adverse pregnancy outcomes in women infected with HIV in Latin America and the Caribbean: a cohort study

“…[2][3][4] It has been known that SGA, LBW, and PT are associated with increased neonatal mortality and significant long-term morbidity, including neurocognitive deficits, and chronic respiratory and metabolic problems. [5][6][7][8] Some of the predictors for these outcomes have been described, but there is limited information from Latin America in the era of routine use of highly active ARV therapy (HAART).…”