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Pregnancy outcomes in HIV-positive women: a retrospective cohort study

Archives of Gynecology and Obstetrics volume 295, pages 599–606 (2017)Cite this article

Abstract

Purpose

In the United States, an estimated 8500 HIV (human immunodeficiency virus) positive women gave birth in 2014. This rate appears to be increasing annually. Our objective is to examine obstetrical outcomes of pregnancy among HIV-positive women.

Methods

A population-based cohort study was conducted using the Nationwide Inpatient Sample database (2003–2011) from the United States. Pregnant HIV-positive women were identified and compared to pregnant women without HIV. Multivariate logistic regression was used to estimate the adjusted effect of HIV status on obstetrical and neonatal outcomes.

Results

Among 7,772,999 births over the study period, 1997 were in HIV-positive women (an incidence of 25.7/100,000 births). HIV-infected patients had greater frequency of pre-existing diabetes and chronic hypertension, and use of cigarettes, drugs, and alcohol during pregnancy (p < 0.001). Upon adjustment for baseline characteristics, HIV-infected women had greater likelihood of antenatal complications: preterm premature rupture of membranes (OR 1.35, 95% CI 1.14–1.60) and urinary tract infections (OR 3.02, 95% CI 2.40–3.81). Delivery and postpartum complications were also increased among HIV-infected women: cesarean delivery (OR 3.06, 95% CI 2.79–3.36), postpartum sepsis (OR 8.05, 95% CI 5.44–11.90), venous thromboembolism (OR 2.21, 95% CI 1.46–3.33), blood transfusions (OR 3.67, 95% CI 3.01–4.49), postpartum infection (OR 3.00, 95% CI 2.37–3.80), and maternal mortality (OR 21.52, 95% CI 12.96–35.72). Neonates born to these mothers were at higher risk of prematurity and intrauterine growth restriction.

Conclusion

Pregnancy in HIV-infected women is associated with adverse maternal and newborn complications. Pregnant HIV-positive women should be followed in high-risk healthcare centers.

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References

  1. World Health Organization (2015) Media Centre. HIV/AIDS Fact Sheet No 360. http://www.who.int/mediacentre/factsheets/fs360/en/. Accessed 25 April 2016

  2. HIV Among Women. Fast Facts. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/group/gender/women/. Accessed 1 Aug 2016

  3. Centers for Disease Control and Prevention (2015) HIV Surveillance Report, 2014; vol. 26. http://cdc.gov/cdc-info/requestform.html. Accessed 7 April 2016

  4. CDC CfDCaPNCfHA, Viral Hepatitis, STD, and TB Prevention (2016 ) Division of HIV/AIDS Prevention. HIV among pregnant women, infants, and children 2016. http://www.cdc.gov/hiv/group/gender/pregnantwomen/. Accessed March 2016

  5. Reitter A, Stucker AU, Linde R, Konigs C, Knecht G, Herrmann E et al (2014) Pregnancy complications in HIV-positive women: 11-year data from the Frankfurt HIV Cohort. HIV Med 15:525–536

    CAS  Article  PubMed  Google Scholar 

  6. Yudin MH, Caprara D, MacGillivray SJ, Urquia M, Shah RR (2016) A ten-year review of antenatal complications and pregnancy outcomes among HIV-positive pregnant women. J Obstet Gynaecol Can 38:35–40

    Article  PubMed  Google Scholar 

  7. Marti C, Pena JM, Bates I, Madero R, de Jose I, Pallardo LF et al (2007) Obstetric and perinatal complications in HIV-infected women. Analysis of a cohort of 167 pregnancies between 1997 and 2003. Acta Obstet Gynecol Scand 86:409–415

    Article  PubMed  Google Scholar 

  8. Brocklehurst P, French R (1998) The association between maternal HIV infection and perinatal outcome: a systematic review of the literature and meta-analysis. Br J Obstet Gynaecol 105:836–848

    CAS  Article  PubMed  Google Scholar 

  9. Ewing AC, Datwani HM, Flowers LM, Ellington SR, Jamieson DJ, Kourtis AP (2016) Trends in hospitalizations of pregnant HIV-infected women in the United States: 2004 through 2011. Am J Obstet Gynecol 215:499e1–499e8

    Article  Google Scholar 

  10. Kourtis AP, Bansil P, McPheeters M, Meikle SF, Posner SF, Jamieson DJ (2006) Hospitalizations of pregnant HIV-infected women in the USA prior to and during the era of HAART, 1994–2003. AIDS (London, England) 20:1823–31

  11. Gonzalez-Tome MI, Ramos Amador JT, Guillen S, Solis I, Fernandez-Ibieta M, Munoz E et al (2008) Gestational diabetes mellitus in a cohort of HIV-1 infected women. HIV Med 9:868–874

    CAS  Article  PubMed  Google Scholar 

  12. Lopez M, Figueras F, Hernandez S, Lonca M, Garcia R, Palacio M, et al (2012) Association of HIV infection with spontaneous and iatrogenic preterm delivery: effect of HAART. AIDS (London, England) 26:37–43

  13. Kourtis AP, Schmid CH, Jamieson DJ, Lau J (2007) Use of antiretroviral therapy in pregnant HIV-infected women and the risk of premature delivery: a meta-analysis. AIDS (London, England) 21:607–615

  14. Rasmussen LD, Dybdal M, Gerstoft J, Kronborg G, Larsen CS, Pedersen C et al (2011) HIV and risk of venous thromboembolism: a Danish nationwide population-based cohort study. HIV Med 12:202–210

    CAS  Article  PubMed  Google Scholar 

  15. Jansen JM, Lijfering WM, Sprenger HG, van der Meer J, van Pampus MG (2008) Venous thromboembolism in HIV-positive women during puerperium: a case series. Blood Coagul Fibrinolysis 19:95–97

    Article  PubMed  Google Scholar 

  16. Weiss AJ, Elixhauser A (2006) Overview of Hospital Stays in the United States, 2012: Statistical Brief #180. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Health Care Policy and Research (US)

  17. Berthelsen CL (2000) Evaluation of coding data quality of the HCUP National Inpatient Sample. Top Health Inform Manag 21:10–23

    CAS  Google Scholar 

  18. NIS Description of Data Elements. https://www.hcup-us.ahrq.gov/db/vars/zipinc_qrtl/nisnote.jsp. Accessed 1 Aug 2016

  19. Reshi P, Lone IM (2010) Human immunodeficiency virus and pregnancy. Arch Gynecol Obstet 281:781–792

    Article  PubMed  Google Scholar 

  20. Gilling-Smith C, Nicopoullos JD, Semprini AE, Frodsham LC (2006) HIV and reproductive care—a review of current practice. BJOG 113:869–878

    CAS  Article  PubMed  Google Scholar 

  21. Barnhart N, Shannon M, Weber S, Cohan D (2009) Assisted reproduction for couples affected by human immunodeficiency virus in California. Fertil Steril 91:1540–1543

    Article  PubMed  Google Scholar 

  22. Frodsham LC, Boag F, Barton S, Gilling-Smith C (2006) Human immunodeficiency virus infection and fertility care in the United Kingdom: demand and supply. Fertil Steril 85:285–289

    Article  PubMed  Google Scholar 

  23. Chen JL, Philips KA, Kanouse DE, Collins RL, Miu A (2001) Fertility desires and intentions of HIV-positive men and women. Fam Plan Perspect 33(144–52):65

    Google Scholar 

  24. Warszawski J, Tubiana R, Le Chenadec J, Blanche S, Teglas JP, Dollfus C, et al (2008) Mother-to-child HIV transmission despite antiretroviral therapy in the ANRS French Perinatal Cohort. AIDS (London, England) 22:289–299

  25. European Collaborative S (2005) Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. Clin Infect Dis 40:458–465

    Article  Google Scholar 

  26. Semprini AE, Levi-Setti P, Bozzo M, Ravizza M, Taglioretti A, Sulpizio P et al (1992) Insemination of HIV-negative women with processed semen of HIV-positive partners. Lancet 340:1317–1319

    CAS  Article  PubMed  Google Scholar 

  27. Pena JE, Thornton MH, Sauer MV (2003) Assessing the clinical utility of in vitro fertilization with intracytoplasmic sperm injection in human immunodeficiency virus type 1 serodiscordant couples: report of 113 consecutive cycles. Fertil Steril 80:356–362

    Article  PubMed  Google Scholar 

  28. Gingelmaier A, Wiedenmann K, Sovric M, Mueller M, Kupka MS, Sonnenberg-Schwan U et al (2011) Consultations of HIV-infected women who wish to become pregnant. Arch Gynecol Obstet 283:893–898

    Article  PubMed  Google Scholar 

  29. Kourtis AP, Ellington S, Pazol K, Flowers L, Haddad L, Jamieson DJ (2014) Complications of cesarean deliveries among HIV-infected women in the United States. AIDS (London, England) 28:2609–2618

  30. Mandelbrot L, Le Chenadec J, Berrebi A, Bongain A, Benifla JL, Delfraissy JF et al (1998) Perinatal HIV-1 transmission: interaction between zidovudine prophylaxis and mode of delivery in the French Perinatal Cohort. JAMA 280:55–60

    CAS  Article  PubMed  Google Scholar 

  31. (1999). The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1–a meta-analysis of 15 prospective cohort studies. The International Perinatal HIV Group. N Engl J Med 340:977–987

  32. European Mode of Delivery C (1999) Elective caesarean-section versus vaginal delivery in prevention of vertical HIV-1 transmission: a randomised clinical trial. Lancet 353:1035–1039

    Article  Google Scholar 

  33. Committee on Obstetric P (2001) ACOG committee opinion scheduled Cesarean delivery and the prevention of vertical transmission of HIV infection. Number 234, May 2000 (replaces number 219, August 1999). Int J Gynaecol Obstet 73:279–281

    Article  Google Scholar 

  34. Briand N, Jasseron C, Sibiude J, Azria E, Pollet J, Hammou Y et al (2013) Cesarean section for HIV-infected women in the combination antiretroviral therapies era, 2000-2010. Am J Obstet Gynecol 209:335.e1–335.e12

    Article  Google Scholar 

  35. Islam S, Oon V, Thomas P (2010) Outcome of pregnancy in HIV-positive women planned for vaginal delivery under effective antiretroviral therapy. J Obstet Gynaecol 30:38–40

    CAS  Article  PubMed  Google Scholar 

  36. CDC (2006) Achievements in Public Health: Reduction in Perinatal Transmission of HIV Infection—United States, 1985–2005

  37. Townsend CL, Cortina-Borja M, Peckham CS, de Ruiter A, Lyall H, Tookey PA (2008) Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000–2006. AIDS (London, England) 22:973–981

  38. Hooton TM, Scholes D, Hughes JP, Winter C, Roberts PL, Stapleton AE et al (1996) A prospective study of risk factors for symptomatic urinary tract infection in young women. N Engl J Med 335:468–474

    CAS  Article  PubMed  Google Scholar 

  39. Park JC, Buono D, Smith DK, Peipert JF, Sobel J, Rompalo A et al (2002) Urinary tract infections in women with or at risk for human immunodeficiency virus infection. Am J Obstet Gynecol 187:581–588

    Article  PubMed  Google Scholar 

  40. Bansil P, Jamieson DJ, Posner SF, Kourtis AP (2007) Hospitalizations of pregnant HIV-infected women in the United States in the era of highly active antiretroviral therapy (HAART). J Women’s Health 16:159–162

    Article  Google Scholar 

  41. Graham WHJ (2003) Measuring and estimating maternal mortality in the era of HIV/AIDS. Workshop on HIV/AIDS and adult mortality in developing countries. Population Division, New York

    Google Scholar 

  42. Aagaard-Tillery KM, Lin MG, Lupo V, Buchbinder A, Ramsey PS (2006) Preterm premature rupture of membranes in human immunodeficiency virus-infected women: a novel case series. Infect Dis Obstet Gynecol 2006:53234

    Article  PubMed  PubMed Central  Google Scholar 

  43. Minkoff H, Burns DN, Landesman S, Youchah J, Goedert JJ, Nugent RP et al (1995) The relationship of the duration of ruptured membranes to vertical transmission of human immunodeficiency virus. Am J Obstet Gynecol 173:585–589

    CAS  Article  PubMed  Google Scholar 

  44. Xiao PL, Zhou YB, Chen Y, Yang MX, Song XX, Shi Y et al (2015) Association between maternal HIV infection and low birth weight and prematurity: a meta-analysis of cohort studies. BMC Pregnancy Childbirth 15:246

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kourtis AP, Fowler MG (2011) Antiretroviral use during pregnancy and risk of preterm delivery: more questions than answers. J Infect Dis 204:493–494

    Article  PubMed  Google Scholar 

  46. Townsend CL, Cortina-Borja M, Peckham CS, Tookey PA (2007) Antiretroviral therapy and premature delivery in diagnosed HIV-infected women in the United Kingdom and Ireland. AIDS (London, England) 21:1019–1026

  47. Auerbach E, Aboulafia DM (2012) Venous and arterial thromboembolic complications associated with HIV infection and highly active antiretroviral therapy. Semin Thromb Hemost 38:830–838

    CAS  Article  PubMed  Google Scholar 

  48. Chen JY, Ribaudo HJ, Souda S, Parekh N, Ogwu A, Lockman S et al (2012) Highly active antiretroviral therapy and adverse birth outcomes among HIV-infected women in Botswana. J Infect Dis 206:1695–1705

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  49. Ezechi OC, Gab-Okafor CV, Oladele DA, Kalejaiye OO, Oke BO, Ohwodo HO et al (2013) Pregnancy, obstetric and neonatal outcomes in HIV positive Nigerian women. Afr J Reprod Health 17:160–168

    CAS  PubMed  Google Scholar 

  50. HIV and AIDS in Canada. Surveillance Report to December 31, 2008. Ottawa: Surveillance and Risk Assessment Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, 2009

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Author information

Affiliations

  1. Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Pav H, Room 325, 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada

    Kholoud Arab & Haim A. Abenhaim

  2. Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada

    Andrea R. Spence, Nicholas Czuzoj-Shulman & Haim A. Abenhaim

Authors
  1. Kholoud Arab
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  2. Andrea R. Spence
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  3. Nicholas Czuzoj-Shulman
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  4. Haim A. Abenhaim
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Corresponding author

Correspondence to Haim A. Abenhaim.

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This study did not receive any funding.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study exclusively used publicly available data; hence, according to the Tri-Council Policy Statement (2010), institutional review board approval was not required.

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Arab, K., Spence, A.R., Czuzoj-Shulman, N. et al. Pregnancy outcomes in HIV-positive women: a retrospective cohort study. Arch Gynecol Obstet 295, 599–606 (2017). https://doi.org/10.1007/s00404-016-4271-y

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  • DOI: https://doi.org/10.1007/s00404-016-4271-y

Keywords

  • Anti-retroviral treatment
  • Human immunodeficiency virus
  • Obstetrical outcomes