Preterm prelabour rupture of membranes (PPROM) and pregnancy outcomes in association with HIV-1 infection in KwaZulu-Natal, South Africa

Abstract

Background: SubSaharan Africa has a disproportionate burden of HIV and preterm births (PTB). We hypothesized that PTB in HIV-1 infected women are more likely a result of prelabour rupture of membranes (PROM) and could lead to worse birth outcomes than HIV-uninfected women. We also hypothesized that PPROM increased the risk of mother-to-child transmission (MTCT) of HIV-1. Current clinical management protocols for PPROM do not include a differential treatment plan for HIV-infected women. Methods: The maternity register at a regional hospital in a high HIV-burden district in South Africa was reviewed to identify all preterm births over a 3 month-period in 2018. We determined the incidence of PPROM using predefined criteria. Maternal age, parity, previous pregnancy complications, antenatal care, body mass index, history of smoking or alcohol, HIV infection and syphilis were computed on chi-square contingency tables to determine risk of PPROM. Overall pregnancy outcomes that included mode of delivery, fetal survival, birth weight, gestational age and newborn apgar scores were compared between HIV-infected and HIV-uninfected women whose pregnancies were complicated by PPROM. HIV-exposed newborns are routinely tested at birth for HIV by PCR. Results: A total of 1758 deliveries were recorded for Jan-Mar, 2018, and 295 (16.8%) were preterm. Maternity charts were retrieved for 236 (80.0%) PTB; 47 of PTB (19.9%; 95%CI 15.0-25.6) were further complicated by PROM which translates to 2.7% (95%CI 1.9-3.4) of all deliveries. None of the risk variables including HIV-positive status (48.9% vs 47.6%) were different between PPROM and non-PPROM groups and the majority of women were receiving cART (94.7 and 92.0%). There were no differences in the proportion of low birth weight (RR 1.2 95%CI 0.6-2.1) or severe preterm birth (RR 1.6; 95%CI 0.9-2.9) between HIV-infected and HIV-uninfected women whose pregnancies were complicated by PPROM. None of the 22 HIV-exposed newborns in the PPROM group were HIV-infected at birth. Conclusion: The PPROM incidence is not higher among HIV-infected women and our findings suggest that HIVinfected women who are virally suppressed on cART and presenting with PPROM are less likely to transmit HIV to their infants and do not have worse birth outcomes than HIV-uninfected women.

Prevalence of premature rupture of membrane and its associated factors among pregnant women in Ethiopia: A systematic review and meta-analysis

“…A disproportionate burden of prematurity due to PROM leads to increased neonatal mortality and morbidity in Sub-Saharan African countries. 43 , 44 In Ethiopia, PROM is one of the major causes of prematurity and infection, which in turn are the leading cause of neonatal death. 13 , 28 In addition, puerperal infection, chorioamnionitis, and disseminated intravascular coagulopathy are among the causes of maternal sufferings linked with PROM.…”

The Association Between Vaginal Microbiota Dysbiosis, Bacterial Vaginosis, and Aerobic Vaginitis, and Adverse Pregnancy Outcomes of Women Living in Sub-Saharan Africa: A Systematic Review

“…However, in the study conducted by Thorsen et al, BV was not associated with PTB in a Danish population ( 94 ). In low-income countries, including some countries from sub-Saharan Africa, spontaneous preterm PROM contributes to a third of all PTB ( 17 , 99 ). In the current review, two studies found a positive association between BV and PROM ( 72 , 77 ).…”

Luaran Maternal dan Perinatal Kehamilan dengan HIV di RSUP dr. Kariadi Semarang Tahun 2019-2021

“…Menurut Onwughara CE dkk insiden kejadian ketuban pecah dini tidak tinggi pada ibu hamil yang terinfeksi HIV. 24 Jurnal Kesehatan Reproduksi Volume 10 No 1, April 2023: 1-8…”