Hypertensive disorders of pregnancy and HIV: analysis of a province-wide cohort during 2018 and 2019

Slogrove, Amy L.; Davies, Mary‐Ann; Phelanyane, Florence; Beer, Shani De; Theron, Gerhard; Williams, Paige L.; Abrams, Elaine J.; Cotton, Mark F.; Boulle, Andrew

doi:10.1097/qad.0000000000003506

Cited by 5 publications

(4 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consequently, there may be an increased likelihood of misdiagnosing severe forms of hypertension in pregnancy such as HELLP syndrome and preeclampsia. This is in contradiction to a study which concluded long term ART could be protective in hypertensive disorders in pregnancy 16 . Unfortunately, there is a lack of data on the type of hypertension and Vol 12.…”

Section: Discussioncontrasting

confidence: 97%

Human Immunodeficiency Virus in Pregnancy a Retrospective Study on Maternal and Perinatal Outcomes

Muralikrishnan Nambiar,

Nikhil shetty,

Athulya sreenivas

et al. 2024

Indones J Obstet Gynecol

View full text Add to dashboard Cite

Objective: To assess the maternal and perinatal outcome in pregnant women with HIV infection and the role of Antiretroviral therapy in reducing complications of pregnancy. Methods: A retrospective analysis was conducted on data from HIV-positive mothers receiving antenatal care at a tertiary care center between February 2015 and January 2020. The study examined various adverse pregnancy outcomes in relation to antiretroviral treatment. Statistical analysis employed chi-square and Fisher’s exact tests to determine differences in distribution proportions of patients on ART versus those not on ART across various antenatal and neonatal complications, with significance attributed to p-values <0.05. Results: A total of 155 patients were found to be HIV positive. Out of this 58 were diagnosed before pregnancy and 97 during pregnancy. Miscarriage was seen in one (0.6%) patient on ART and two (1.2%) not on treatment (p-value 0.6). Sixteen (10.3%) patients underwent medical termination of pregnancy (MTP); all were given HIV-positive status and they were all on ART (p-value <0.001). Anemia was seen in eighteen (11.6%) patients out of which 14(9%) were on ART (p-value 0.01). One (0.64%) woman had thrombocytopenia and she was on ART (p-value 1). Two (1.2%) patients on ART had diabetes mellitus (p-value 0.4). One (0.64%) patient who was on ART developed polyhydramnios (p-value 1). A total of 8 (5.16%) women had hypertensive disorders; out of which 4(2.58%) were on ART (p-value 1). 11(7.09%) patients who were on ART and 6(3.8%) not on ART had preterm labor (p-value 0.2). 12(7.74%) patients who were not on ART had intrauterine growth restriction (IUGR) and 2(1.29%) on ART had IUGR. A total of 6(3.87%) patients had Intrauterine fetal demise (IUFD), of which 3(1.93%) were on ART and 3(1.93%) were not (p-value 1). Pre-labour rupture of membranes (PROM) was observed in 2(1.29%) women on ART and 11(7.09%) patients not on ART (p-value 0.004). All women (100%) had CD4 counts more than 500. All (100%) babies delivered at our center received antiretroviral therapy either with oral Nevirepine. Almost half the women (51.6%) had vaginal delivery. Almost one-fourth, 41(26.4%) had a cesarean section. All caesareans were done given obstetric indications. There were no instrumental deliveries. Our study had a total of 122 live births. All 122(100%) babies were exclusively breastfed. None of the babies delivered in our center developed HIV on follow up which was done at 6 weeks and 6 months. Nine (5.8%) patients had infections. None of these women were on ART(p-value < 0.001). Conclusion: HIV infection during pregnancy is associated with various adverse outcomes, but ART plays a crucial role in mitigating these risks and preventing mother-to-child HIV transmission. Initiating ART in all HIV-positive mothers and their infants is essential regardless of HIV status. Keywords: anemia, ART, HIV, MTP, Perinatal outcome, PROM.

show abstract

Section: Discussioncontrasting

confidence: 97%

Human Immunodeficiency Virus in Pregnancy a Retrospective Study on Maternal and Perinatal Outcomes

Muralikrishnan Nambiar,

Nikhil shetty,

Athulya sreenivas

et al. 2024

Indones J Obstet Gynecol

View full text Add to dashboard Cite

show abstract

“…Our finding that the risk of elevated blood pressure in pregnancy did not differ by HIV status largely aligns with previous literature on HIV and hypertensive disorders in pregnancy [ 21 , 58–60 ], including a recent population-based cohort study form the Western Cape province in South Africa [ 61 ]. While these findings are reassuring, the fact that a third of the cohort had elevated blood pressure or higher postpartum is concerning.…”

Section: Discussionsupporting

confidence: 89%

Cardiometabolic Health in Pregnancy and Postpartum: Findings From a Prospective Cohort Study in South Africa

Bengtson,

Madlala,

Matjila

et al. 2024

Open Forum Infectious Diseases

View full text Add to dashboard Cite

Background The cardiometabolic impact of HIV infection and treatment with antiretroviral therapy (ART) in pregnancy and the postpartum period remains unclear. Methods We enrolled pregnant persons with (PHIV) and without HIV in Cape Town, South Africa who were ≥18 years old at 24-28 weeks gestation and followed them up to 32 months postpartum. We estimated associations between HIV status and cardiometabolic risk including body mass index (BMI), obesity (BMI ≥ 30 kg/m2), blood pressure (BP, elevated systolic BP ≥130 and/or diastolic ≥85 mmHg; ), lipid levels, and metabolic syndrome according to the Joint Interim Statement criteria using multivariable log binomial or linear regression models. Sub-group analyses compared PHIV on efavirenz (EFV)- versus dolutegravir (DTG)-based ART. Results Among 400 participants (n = 200 without HIV, n = 200 PHIV), 52% had pre-pregnancy obesity and 9% elevated BP. By postpartum, 57% were classified with obesity, 31% had elevated BP, and 29% had metabolic syndrome. In multivariable analyses, HIV was associated with a lower BMI pre-pregnancy but not postpartum; however, mean indices were in the obese range regardless of HIV status. Neither BMI nor obesity pre-pregnancy or postpartum differed by ART regimen. Among PHIV, participants on DTG had higher levels of elevated BP in pregnancy and postpartum, compared to PHIV on EFV. Conclusions We observed high levels of obesity, elevated BP, and metabolic syndrome in the perinatal period but few differences by HIV status. Participants on DTG may be more likely to have elevated BP in pregnancy and postpartum. Monitoring of cardiometabolic health for pregnant persons on DTG is warranted.

show abstract

“…This was a province-wide retrospective cohort study of pregnant people delivering from 1 January 2018 to 31 December 2019 at all 54 public sector healthcare facilities that provide obstetric delivery services in the Western Cape. Algorithms used by the WCPHDC to identify pregnancy, the identification of this specific 2018–2019 maternity cohort and classification of dnHDP have been described [ 20 , 21 ]. For this analysis, the cohort was restricted to the first viable (i.e.…”

Section: Methodsmentioning

confidence: 99%

Maternal and birth outcomes in pregnant people with and without HIV in the Western Cape, South Africa

Slogrove,

Bovu,

de Beer

et al. 2023

Aids

Self Cite

View full text Add to dashboard Cite

Introduction: We evaluated associations of HIV and antiretroviral therapy (ART) with birth and maternal outcomes at a province-wide-level in the Western Cape, South Africa, in a recent cohort before dolutegravir-based first-line ART implementation. Methods: This retrospective cohort study included pregnant people delivering in 2018-2019 with data in the Western Cape Provincial Health Data Centre which integrates individual-level data on all public sector patients from multiple electronic platforms using unique identifiers. Adverse birth outcomes (stillbirth, low birth weight (LBW), very LBW (VLBW)) and maternal outcomes (early and late pregnancy-related deaths, early and late hospitalizations) were compared by HIV/ART status and adjusted prevalence ratios (aPRs) calculated using log-binomial regression. Results: Overall 171,960 pregnant people and their singleton newborns were included, 19% (N = 32,015) identified with HIV. Amongst pregnant people with HIV (PPHIV), 60% (N = 19,157) were on ART preconception, 29% (N = 9,276) initiated ART during pregnancy and 11% (N = 3,582) had no ART. Adjusted for maternal age, multiparity, hypertensive disorders and residential district, stillbirths were higher only for PPHIV not on ART (aPR 1.31 [95%CI 1.04–1.66]) compared to those without HIV. However, LBW and VLBW were higher among all PPHIV, with aPRs of 1.11–1.22 for LBW and 1.14–1.54 for VLBW. Pregnancy-initiated ART was associated with early pregnancy-related death (aPR 3.21; 95%CI 1.55–6.65), and HIV with or without ART was associated with late pregnancy-related death (aPRs 7.89–9.01). Conclusions: Even in the universal ART era, PPHIV experienced higher rates of LBW and VLBW newborns, and higher late pregnancy-related death regardless of ART status than pregnant people without HIV.

show abstract

Hypertensive disorders of pregnancy and HIV: analysis of a province-wide cohort during 2018 and 2019

Cited by 5 publications

References 33 publications

Human Immunodeficiency Virus in Pregnancy a Retrospective Study on Maternal and Perinatal Outcomes

Human Immunodeficiency Virus in Pregnancy a Retrospective Study on Maternal and Perinatal Outcomes

Cardiometabolic Health in Pregnancy and Postpartum: Findings From a Prospective Cohort Study in South Africa

Maternal and birth outcomes in pregnant people with and without HIV in the Western Cape, South Africa

Contact Info

Product

Resources

About