Risk of intrauterine growth restriction among HIV-infected pregnant women: a cohort study

Abstract

The purpose of this investigation was to study the risk of intrauterine growth restriction in human immunodeficiency virus (HIV)-infected women and to describe the associated risk factors. A cohort study was performed among HIV-infected women who delivered in a single tertiary centre in Barcelona, Spain, from January 2006 to December 2011. Consecutive singleton pregnancies delivered beyond 22 weeks of pregnancy were included. Intrauterine growth restriction (IUGR) was defined as a birth weight below the 10th customised centile for gestational age and IUGR babies were compared to non-IUGR newborns. Intrauterine Doppler findings were described among IUGR foetuses. Baseline characteristics, HIV infection data and perinatal outcome were compared between groups. The results were adjusted for potential confounders. A total of 156 singleton pregnancies were included. IUGR occurred in 23.4 % of cases (38/156). In two-thirds of the cases detected before birth, Doppler abnormalities compatible with placental insufficiency were observed. IUGR pregnancies presented a worse perinatal outcome, mainly due to a higher risk of iatrogenic preterm delivery [adjusted odds ratio 6.9, 95 % confidence interval (CI) 1.4-33.5]. IUGR foetuses also had a higher risk of emergent Caesarean section and neonatal intensive care unit admission. No cases of intrauterine foetal death occurred. A high rate of IUGR was observed among HIV pregnancies, and it was associated with adverse perinatal outcomes, mainly iatrogenic preterm and very preterm birth due to placental insufficiency. Our results support that ultrasound detection and follow-up of IUGR foetuses should be part of routine antenatal care in this high-risk population to improve antenatal management.

Prenatal inflammation exposure-programmed cardiovascular diseases and potential prevention

“…For example, individuals infected with influenza produce a lower proportion of preterm births (8.0%) and low birth weight newborns (4.7%) (Acs, Banhidy, Puho, & Czeizel, 2006;Doyle, Goodin, & Hamilton, 2013;S. S. Lee & Wong, 2012); women with circulating hepatitis B virus (HBV) DNA show a higher proportion of spontaneous preterm births (7.3%) than women without HBV infection (1.6%) (Elefsiniotis, et al, 2010;Mouloudi, et al, 2012;Sirilert, Traisrisilp, Sirivatanapa, & Tongsong, 2014); the incidence of preterm delivery is 19.7% in human immunodeficiency virus (HIV)-infected women and 8.5% in healthy women (López, et al, 2016;Lopez, et al, 2012;Lopez, et al, 2015;Rollins, et al, 2007;Uneke, Duhlinska, & Ujam, 2009); prematurity is 77% higher in infants of mothers with malaria caused by Plasmodium falciparum than in infants of mothers with malaria by caused by Plasmodium vivax (Botto-Menezes, et al, 2015;Nair & Nair, 1993;Tobon-Castano, Solano, Sanchez, & Trujillo, 2011). In addition, urogenital infections during pregnancy, such as bacterial vaginosis (Klebanoff, et al, 2005), placental malaria infection (Menendez, et al, 2000;Oraneli, Okeke, & Ubachukwu, 2013), Chlamydia trachomatis infection (Baud, et al, 2015;Rours, et al, 2011), schistosomiasis (Mombo-Ngoma, et al, 2017),…”

Maternal and fetal outcomes in HIV positive pregnant female

“…A high rate of IUGR has been observed among HIV pregnancies, probably due to placental insufficiency. 12 HIV infection in mother itself can cause IUGR. 13 SGA babies are at a higher risk for peripartum HIV transmission but in our study all four babies who found HIV positive, had birth weight ≥2.5kg, hence further research is needed to study the mechanism of transmission in relation to birth weight.…”

Provision of combined antiretroviral therapy in HIV-positive pregnant women and the increased risk of apoptosis-related intra-uterine growth restriction

“…Lopez et al reported 23.4% for cases of IUGR diagnosed antenatally. Two thirds of those cases were associated with abnormal umbilical artery Doppler study, which indicates placental insufficiency [3]. The Women and Infants Transmission Study (WITS) reported 21% for cases of preterm births and 19% for cases of low birth weight, while Lambert et al reported 17% and 13% for cases of low birth weight and IUGR in HIV-positive women respectively.…”

“…The Women and Infants Transmission Study (WITS) reported 21% for cases of preterm births and 19% for cases of low birth weight, while Lambert et al reported 17% and 13% for cases of low birth weight and IUGR in HIV-positive women respectively. Neonates with IUGR were associated with iatrogenic preterm birth and needed a longer NICU stay [3][4][5]. Mittal et al reported that in a group of patients who received longer cART, the incidence of IUGR was 27%, which was associated with apoptosis-related placental insufficiency [6].…”