Fetomaternal outcome of HIV-infected pregnant women delivering at a tertiary health-care center of South Gujarat

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Abstract

Aim:

The aim of this study was to document the fetomaternal outcome in HIV-infected pregnant women delivering at a tertiary health-care center of South Gujarat.

Subjects and Methods:

This study was a secondary data analysis of pregnant HIV-infected women delivering between May 2017 and April 2021 in the Department of Obstetrics and Gynecology, a tertiary health-care center of South Gujarat.

Statistical Analysis:

Secondary data analysis was performed using IBM SPSS ver. 20.0 (IBM SPSS Corp., Armonk, NY, USA).

Results:

A total of 145 HIV-infected pregnant women were delivered at our institute during the study period. Thirteen (8.97%) participants had preterm delivery. Eighty-eight (60.68%) of the 145 participants had vaginal delivery and 57 (39.32%) underwent cesarean section. One hundred and forty-three (98.62%) of our 145 participants had live births, whereas 2 (1.38%) had stillbirths. Most of the newborns, i.e., 96 (64.43%) had a birth weight of between 2 and 3 kg, and 25 (16.77%) had a birth weight of <2 kg. Out of 147 live-born babies, 36 (24.48%) babies were admitted to the neonatal intensive care unit NICU.

Conclusion:

Although the HIV positivity in our general population is <1%, it entails a slightly higher risk of preterm birth and stillbirth for the HIV-positive pregnant women. Early registration and appropriate antenatal care are necessary for optimizing the fetomaternal outcome.

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Most cited references 16

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Association between maternal HIV infection and low birth weight and prematurity: a meta-analysis of cohort studies

Peng Xiao, Yi-Biao Zhou, Yue Chen … (2015)

Background To assess the association between maternal human immunodeficiency virus (HIV) infection and low birth weight (LBW)/prematurity (PTD), we conducted a meta-analysis of cohort studies of HIV infected and uninfected women. Methods Several English and Chinese databases were searched (updated to May 2015) to find the studies reporting infant outcomes associated with exposure to maternal HIV infection during pregnancy. Relevant articles were manually selected based on several inclusion and exclusion criteria. Results Fifty-two cohort studies including 15,538 (for LBW) and 200,896 (for PTD) HIV infected women met the inclusion criteria. There was significant heterogeneity among studies for maternal HIV infection associated with LBW/PTD (I2 = 71.7 %, P < 0.05, and I2 = 51.8 %, P < 0.05 for LBW and PTD, respectively). The meta-analysis demonstrated that the maternal HIV infection was significantly associated with both LBW (pooled odds ratio (OR): 1.73, 95 % confidence interval (CI): 1.64, 1.82, P < 0.001) and PTD (pooled OR: 1.56, 95 % CI: 1.49, 1.63, P < 0.001). No significant difference in the relationship between maternal HIV infection and adverse pregnancy outcomes was detected among the groups of different study periods. HIV infected women were at slightly higher risk of LBW in developing countries compared with women in developed countries (OR: 2.12 (95 % CI: 1.81, 2.48) vs. 1.75 (95 % CI: 1.44, 2.12)). Antiretroviral drugs usage did not significantly change the associations of maternal HIV exposure with LBW and PTD. Conclusions HIV infected women were at higher risk of having a low birth weight infant or a preterm delivery infant compared with uninfected women. Such associations did not change significantly over time or were not significantly affected by the usage of antiretroviral drugs. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0684-z) contains supplementary material, which is available to authorized users.

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Pregnancy outcomes in HIV-infected and uninfected women in rural and urban South Africa.

Michael Bennish, Nigel Rollins, Deven Patel … (2007)

To describe pregnancy outcomes among clade C HIV-infected and uninfected women in South Africa. A longitudinal cohort study. Pregnant women attending 9 rural/urban antenatal clinics were prospectively recruited and followed up. Women were seen at the clinic or at home after delivery on 4 occasions after enrollment: 2 times within the first 2 weeks of the newborn's life at home, and every 2 weeks thereafter until their first health clinic visit when the infant was 6 weeks old. A total of 3465 women were enrolled; 615 withdrew after delivery, moved away, or had a missing or indeterminate HIV status, leaving 2850 women (1449 HIV-infected women). Six women died after delivery and there were 17 spontaneous abortions and 104 stillbirths. An adverse pregnancy outcome was independently associated with HIV infection (adjusted odds ratio [AOR] = 1.63; P = 0.015), urban enrollment (AOR = 0.39; P = 0.020), and nonhospital delivery (AOR = 13.63; P < 0.001) as well as with a CD4 count <200 cells/mL among HIV-infected women (AOR = 1.86; P = 0.127). Among 2529 singleton liveborn babies, birth weight was inversely associated with maternal HIV (AOR = 1.45; P = 0.02) and maternal middle upper arm circumference (AOR = 0.93; P < 0.001). Early infant mortality was not significantly associated with maternal HIV (hazard ratio [HR] = 1.18; P = 0.52) but was with urban sites (HR = 0.34; P = 0.045). Low birth weight substantially increased mortality (AOR = 8.3; P < 0.001). HIV status of infants by 8 weeks of age (14.6%, 95% confidence interval: 12.5% to 17.0%) was inversely associated with maternal CD4 cell count and birth weight. HIV-infected women are at a significantly increased risk of adverse pregnancy outcomes. Low-birth-weight infants of HIV-infected and uninfected women are at substantially increased risk of dying.

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Treatment acceleration program and the experience of the DREAM program in prevention of mother-to-child transmission of HIV.

N Magid, Leonardo Palombi, Albertus Voetberg … (2007)

The Drug Resource Enhancement against AIDS and Malnutrition (DREAM) program is a large antiretroviral therapy treatment program financed by the Treatment Acceleration Program (TAP) of the World Bank. In addition to provision of antiretroviral treatment to individuals infected with human immunodeficiency virus (HIV) in sub-Saharan Africa, one major aspect of the DREAM program is nutritional supplementation and prevention of mother-to-child transmission (PMTCT) of HIV. HIV-positive pregnant women enrolled in the DREAM program receive highly active antiretroviral therapy (HAART) free of charge from the 25th week of gestation, irrespective of clinical stage, CD4 count, and viral load. Their infants receive post-exposure prophylaxis. From 2004 to 2006, women enrolled in the DREAM program in Mozambique, Tanzania, and Malawi received water filters and formula for the first 6 months of lactation. In a second cohort starting in 2005 until 2006 in Mozambique, women received HAART for up to 6 months after delivery and were given the option to breastfeed. We conducted a comparative analysis of the two cohorts of HIV-positive pregnant women followed prospectively and evaluated HIV-1 mother-to-child transmission rates, infant morbidity, and mortality in both cohorts. In the first cohort, 879 live-born children were delivered, with 809 evaluable infants at 1 and 6 months. In the second cohort, 341 infants were delivered and evaluable at 1 month, and 251 infants were evaluable at 6 months. At age 1 month, HIV-1 transmission rates were 4/341 (1.2%) among breastfed infants and 7/809 (0.8%) among formula-fed infants. At age 6 months, HIV-1 mother-to-child transmission rates were 2/251 (0.8%) among breastfed infants of women receiving HAART and 15/809 (1.8%) among formula-fed infants (chi = 0.77, P = 0.38 [NS]). The cumulative incidence rate at 6 months of age was 2.7% for formula-fed infants and 2.2% for breastfed infants (chi = 0.27, P = 0.60 [NS]). There was a trend for HIV-1 infection rates to be slightly greater among formula-fed infants, but overall mother-to-child transmission rates in both cohorts were extremely low. Most infants did relatively well on both feeding regimens. Observed Z scores were greater than among the general infant population in the community. Z scores < or =2.0 for weight by age occurred in 92/809 formula-fed infants (11.4%) and in 28/251 breastfed infants (11.1%). The rates of anemia in the study infant population were also lower than that of the general population. A hemoglobin value <8 g/dl was found in 40/809 formula-fed infants (4.9%) and in 17/251 breastfed infants (6.8%) (chi = 0.92, P = 0.33). The mortality rate at 6 months of age was 27 per 1000 person-years among formula-fed infants and 28.5 per 1000 person-years in breastfed infants--both considerably lower than the rates of 101 per 1000 person-years observed in Mozambique. The DREAM HIV-1 PMTCT protocol was safe and efficacious in reducing transmission in infants of 1 and 6 months of age. Results were comparable to those from developed countries. Breastfeeding among HIV-1 infected mothers receiving HAART posed no additional risk of late postnatal HIV-1 transmission to the infant by 6 months of age.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Sex Transm Dis AIDS

Journal ID (iso-abbrev): Indian J Sex Transm Dis AIDS

Journal ID (publisher-id): IJSTD

Journal ID (publisher-id): Indian J Sex Transm Dis

Title: Indian Journal of Sexually Transmitted Diseases and AIDS

Publisher: Wolters Kluwer - Medknow (India )

ISSN (Print): 2589-0557

ISSN (Electronic): 2589-0565

Publication date (Print): Jan-Jun 2024

Publication date (Electronic): 04 January 2024

Volume: 45

Issue: 1

Pages: 8-10

Affiliations

[1]Departments of Obstetrics and Gynaecology, Government Medical College, Surat, Gujarat, India

Author notes

Address for correspondence: Dr. Ragini N. Verma, Professor Quarters, New Civil Hospital Campus, Surat, Gujarat, India. E-mail: raginiv27@ 123456gmail.com

Article

Publisher ID: IJSTD-45-8

DOI: 10.4103/ijstd.ijstd_6_23

PMC ID: 11233063

PubMed ID: 38989085

SO-VID: c05d742f-99b7-4953-b4c1-ff4742d7184f

License:

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

History

Date received : 23 January 2023

Date revision received : 18 August 2023

Date accepted : 01 September 2023

Fetomaternal outcome of HIV-infected pregnant women delivering at a tertiary health-care center of South Gujarat

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Abstract

Aim:

Subjects and Methods:

Statistical Analysis:

Results:

Conclusion:

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Most cited references 16

Association between maternal HIV infection and low birth weight and prematurity: a meta-analysis of cohort studies

Pregnancy outcomes in HIV-infected and uninfected women in rural and urban South Africa.

Treatment acceleration program and the experience of the DREAM program in prevention of mother-to-child transmission of HIV.

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