Option B+ for prevention of vertical HIV transmission has no influence on adverse birth outcomes in a cross-sectional cohort in Western Uganda

Abstract

BackgroundWhile most Sub-Saharan African countries are now implementing the WHO-recommended Option B+ protocol for prevention of vertical HIV transmission, there is a lack of knowledge regarding the influence of Option B+ exposure on adverse birth outcomes (ABOs). Against this background, we assessed ABOs among delivering women in Western Uganda.MethodsA cross-sectional, observational study was performed within a cohort of 412 mother-newborn-pairs in Virika Hospital, Fort Portal in 2013. The occurrence of stillbirth, pre-term delivery, and small size for gestational age (SGA) was analysed, looking for influencing factors related to HIV-status, antiretroviral drug exposure and duration, and other sociodemographic and clinical parameters.ResultsAmong 302 HIV-negative and 110 HIV-positive women, ABOs occurred in 40.5%, with stillbirth in 6.3%, pre-term delivery in 28.6%, and SGA in 12.2% of deliveries. For Option B+ intake (n = 59), no significant association was found with stillbirth (OR 0.48, p = 0.55), pre-term delivery (OR 0.97, p = 0.92) and SGA (OR 1.5, p = 0.3) compared to seronegative women. Women enrolled on antiretroviral therapy (ART) before conception (n = 38) had no different risk for ABOs than women on Option B+ or HIV-negative women. Identified risk factors for stillbirth included lack of formal education, poor socio-economic status, long travel distance, hypertension and anaemia. Pre-term delivery risk was increased with poor socio-economic status, primiparity, Malaria and anaemia. The occurrence of SGA was influenced by older age and Malaria.ConclusionIn our study, women on Option B+ showed no difference in ABOs compared to HIV-negative women and to women on ART. We identified several non-HIV/ART-related influencing factors, suggesting an urgent need for improving early risk assessment mechanisms in antenatal care through better screening and triage systems. Our results are encouraging with regard to continued universal scale-up of Option B+ and ART programmes.

Timing of combination antiretroviral therapy (cART) initiation is not associated with stillbirth among HIV‐infected pregnant women in Malawi

“…However, a Ugandan study in the era of Option B+ and a systematic review by Uthman et al . found no association between stillbirth and preconception ART or timing of ART initiation respectively .…”

“…A cross‐sectional study in Western Uganda found that stillbirth was not more common among women who were on N(t)RTI/NNRTI‐based antiretroviral combinations than in HIV‐uninfected women, regardless of timing of initiation and adherence to antiretrovirals. The authors suggested that the positive effect of antiretrovirals on maternal HIV infection counterbalances their potential toxicity . A study conducted in Botswana found no differences in stillbirths between pregnant women taking either tenofovir/emtricitabine/efavirenz, other triple ART regimens, or zidovudine only .…”

Determinants of preterm birth among mothers who gave birth in East Africa: systematic review and meta-analysis

“…On history of still birth, [79] [50,56], and shorter pregnancy interval, Mahande et al 2016 [39] showed effects. Besides, on UTI, Mahapula et al2016 [38], malaria, Rempis et al2017 [81], and obstetric complication Mekonen et al 2018 [52] had shown impact. The abovementioned studies were become out of pooled analysis.…”

Comparison of 6-week PMTCT outcomes for HIV-exposed and HIV-unexposed infants in the era of lifelong ART: Results from an observational prospective cohort study

“…Some studies found that adverse birth outcomes, such as increased preterm deliveries, stillbirths and low birth weight, occurred more frequently among HEI [3][4][5][6][7][8]. Other studies found no association between use of ART and adverse birth outcomes [9,10].…”