The study objective was to examine obstetrical outcomes of pregnancy among human immunodeficiency virus positive patients (HIV+).
A population-based cohort study was conducted using the Nationwide Inpatient Sample database (2003–2011). Pregnant HIV+ 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 outcomes.
Among 7,772,999 births over the 9-year study period, 1,997 were in HIV+ women, resulting in an incidence of 25.7/100,000 births. An increasing trend in incidence was observed over study period. HIV+ patients had greater frequency of pre-existing diabetes and chronic hypertension, and more smoking, drug use and alcohol use during pregnancy (P<.001). Upon adjustment for baseline characteristics, HIV+ patients had greater likelihood of antenatal complications: preterm premature rupture of membranes (OR 1.37, 95% CI 1.16–1.63), urinary tract infections (OR 3.01, 95% CI 2.4–3.79), and gestational hypertension (OR 0.67, 95% CI 0.49–0.92). Delivery and postpartum complications including cesarean delivery (OR 3.17, 95% CI 2.88–3.49), postpartum sepsis (OR 8.43, 95% CI 5.71–12.46), venous thromboembolism (OR 2.23, 95% CI 1.47–3.37), blood transfusions (OR 3.11, 95% CI 2.53–3.83), and postpartum depression (OR 2.21, 95% CI 1.78–2.75) were also more common in HIV+ patients. These mothers were at higher risk of delivering prematurely (OR 1.62, 95% CI 1.43–1.83) and having an intrauterine fetal demise (OR 1.72, 95% CI 1.17–2.52). Maternal mortality was also elevated (OR 10.71, 95% CI 5.22–21.96).
Pregnancy in HIV+ patients is associated with adverse maternal and fetal morbidities, including increased risk of maternal mortality.
McGill University, Montreal, Quebec, Canada
Financial Disclosure: The authors did not report any potential conflicts of interest.