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Obstetrical Outcomes of Patients With HIV in Pregnancy, a Population Based Cohort [25]

Arab, Kholoud, MBBS, FRCSC; Czuzoj-Shulman, Nicholas; Spence, Andrea, PhD; Abenhaim, Haim A., MD

Obstetrics & Gynecology: May 2016 - Volume 127 - Issue - p 10S
doi: 10.1097/01.AOG.0000483641.28007.ca
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INTRODUCTION: The study objective was to examine obstetrical outcomes of pregnancy among human immunodeficiency virus positive patients (HIV+).

METHODS: 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.

RESULTS: 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).

CONCLUSION/IMPLICATIONS: 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.

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.