Women living with HIV are potentially at increased risk of
adverse pregnancy outcomes, due to a range of factors, including
immunosuppression, use of combination antiretroviral therapy (ART), and
injecting drug use. Rates of mother-to-child transmission of HIV in Ukraine
have declined to around 2-4%, but little is known about other pregnancy
outcomes in this setting. We used data from an observational prospective cohort
study to assess pregnancy outcomes among HIV-positive women in Ukraine.
The European Collaborative Study (ECS) in EuroCoord is a
continuing cohort study, established in Ukraine in 2000. Eligible women are
those with a diagnosis of HIV infection before or during pregnancy (including
intrapartum) who deliver liveborn babies at seven sites. Maternal
sociodemographic, HIV-related, and delivery (mother and infant) data were
collected with study-specific questionnaires. We used Poisson regression models
to identify factors associated with preterm delivery (before 37 weeks' gestation)
and small weight for gestational age (less than the tenth percentile of weight
for gestational age), based on complete cases.
Between January, 2000, and July, 2012, data were collected
on 8884 HIV-positive mother and liveborn infant pairs. Median maternal age was
26·5 years (IQR 23·1-30·3). 832 (11%) women had WHO stage 3 or 4 HIV and 1474
(17%) had a history of injecting drug use. 7348 (83%) had received antenatal
ART. Among 7435 for whom ART type was available, 4396 (50%) had received zidovudine
monotherapy and 2949 (33%) combination ART. Preterm delivery was seen in 780
(9%, 95% CI 8-9) of 8860 births overall and in 77 (9%, 7-11) of 889 babies with
small size for gestational age. Factors associated with preterm delivery were
history of injecting drug use (adjusted risk ratio 1·64, 95% CI 1·38-1·95), no
ART (2·94, 2·43-3·57 vs zidovudine monotherapy), antenatal combination ART
(1·40, 1·14-1·73 vs zidovudine monotherapy), WHO stage 4 HIV (2·42, 1·71-3·41
vs WHO stage 1), and being in the most socially deprived group (1·38,
1·11-1·71). Small size for gestational age was associated with history of
injecting drug use (adjusted RR 1·39, 95% CI 1·16-1·65), most socially deprived
(1·32, 1·09-1·61), no ART (1·60, 1·32-1·94 vs zidovudine monotherapy), and
antenatal combination ART (1·33, 1·12-1·60 vs zidovudine monotherapy).
Some risk factors for adverse pregnancy outcomes were
directly associated with HIV and treatment and others were shared with the
general antenatal population. Monitoring of pregnancy outcomes in Ukraine will
be important as use of antenatal combination ART increases.
Via: http://goo.gl/jeSMZG Purchase
full article at: http://goo.gl/loqS9k
By:
- 1Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK.
- 2Perinatal Prevention of AIDS Initiative, Odessa, Ukraine.
- 3Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine.
- 4Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK.
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