Time trends in perinatal outcomes among HIV-positive pregnant women in Northern Tanzania: A registry-based study

Abstract

Introduction Maternal HIV infection is associated with increased risk of having a preterm delivery, low birth weight baby, small for gestational age baby and stillbirth. Maternal use of combination antiretroviral treatment is also associated with preterm delivery and low birth weight, although the effects vary by the type of drugs and timing of initiation. Objective To examine time trends in adverse perinatal outcomes among HIV-positive compared with HIV-negative women. Design Registry-based cohort study. Setting Northern Tanzania, 2000–2018. Study sample Mother-baby pairs of singleton deliveries (n = 41 156). Methods Perinatal outcomes of HIV-positive women were compared with HIV-negative women during time periods representing shifts in prevention of mother-to-child transmission guidelines. Monotherapy was used as first-line therapy before 2007 while combination antiretroviral treatment was routinely used from 2007. Log binomial and quantile regression were used to analyze the data. Main outcome measures Preterm delivery, low birth weight, perinatal death, stillbirth, low Apgar score, transfer to neonatal care unit and small for gestational age. Results Overall, maternal HIV infection was associated with a higher risk of low birth weight and small for gestational age. Moreover, this pattern became more pronounced over time for low birth weight, the last time period being an exception. For other outcomes we found none or only a small overall association with maternal HIV infection, although a trend towards higher risk over time in HIV-positive compared with HIV-negative women was observed for preterm delivery and perinatal death. Quantile regression showed an increase in birth weight in babies born to HIV-negative women over time and a corresponding decline in birth weight in babies born to HIV-positive women. Conclusion Unfavourable trends in some of the selected perinatal outcomes were seen for HIV-positive compared with HIV-negative women. Potential side-effects of combination antiretroviral treatment in pregnancy should be further explored.

Impact of maternal HIV infection on perinatal outcomes: A systematic review

“…In five out of the eight studies that evaluated this outcome, PTB was defined as a birth with a gestational age of fewer than 37 weeks 9,18–21 . The remaining three studies did not provide a gestational age cutoff for preterm 7,10,22 .…”

“…The latter two did not offer a clear definition 10,22 . Using international standards, four studies evaluated SGA outcomes and classified SGA as birth weight below the 10th percentile suitable for gestational age, ethnicity, and sex 9,11,19,23 . In one of the two studies that evaluated this outcome, perinatal mortality was defined as the sum of stillbirths and early neonatal deaths (death during the first 7 days of life) 19 .…”

“…Using international standards, four studies evaluated SGA outcomes and classified SGA as birth weight below the 10th percentile suitable for gestational age, ethnicity, and sex 9,11,19,23 . In one of the two studies that evaluated this outcome, perinatal mortality was defined as the sum of stillbirths and early neonatal deaths (death during the first 7 days of life) 19 . In one of the two studies that evaluated this result, stillbirths were defined as fatalities that occurred both before and during childbirth 19 .…”

“…In one of the two studies that evaluated this outcome, perinatal mortality was defined as the sum of stillbirths and early neonatal deaths (death during the first 7 days of life) 19 . In one of the two studies that evaluated this result, stillbirths were defined as fatalities that occurred both before and during childbirth 19 . In two of the three studies that evaluated this outcome, a low Apgar score was defined as an Apgar score between 1 and 6 measured at 1, 5 or 10 min after birth 19,21 .…”

“…This systematic review adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 19 . We conducted a comprehensive literature search of three reputable databases, PubMed, MEDLINE, and Google Scholar, to identify studies examining the perinatal outcomes of infants born to mothers with HIV infection.…”