Association Between Maternal HIV Infection and the Risks of Preterm Birth and Low Birth Weight in Chengdu, China: a Propensity Score Matching Approach

Overview

Journal BMJ Open

Specialty General Medicine

Date 2023 Sep 7

PMID 37678947

Authors

Luo Yingjuan

Jieru Peng

Yang Liu

Wu Xia

Shan Chen

Sheng Yongcheng

Yonghong Lin

Affiliations

Soon will be listed here.

Abstract

Objectives: To estimate the effect of HIV infection on the risk of preterm birth (PTB) and low birth weight (LBW) among Chinese pregnancy women.

Design: A retrospective cohort study included HIV-positive pregnant women who gave birth to singletons in Chengdu between 2011 and 2020 and and HIV-negative pregnant women who delivered singletons at the Chengdu Women's and Children's Central Hospital in 2020.

Setting: Data of pregnant women living with HIV were extracted from China's Information System of Prevention of Mother-to-Child Transmission of HIV Management. Additionally, information for HIV-negative pregnant women was extracted from the electronic medical record system of the Chengdu Women's and Children's Central Hospital.

Participants: 755 HIV-positive women and 15,094 HIV-negative pregnant women were included.

Primary Outcome Measures: PTB and LBW rates, which were defined by gestational weeks and birth weight.

Results: The incidences of PTB and LBW (13.51% and 14.17%, respectively) were significantly higher in the HIV-positive group compared with the HIV-negative group (6.82% and 4.65%). Propensity score matching was performed to improve comparability of the two groups, resulting in 1590 pregnancies with 558 HIV-positive and 1032 HIV-negative women in the final analysis. Conditional logistic regression was used to estimate the effect of maternal HIV status on adverse pregnancy outcomes. After propensity score matching and controlling the potential confounders, HIV infection was strongly associated with higher chances of LBW and PTB with adjusted odd ratios (95% confidence interval) of 2.53 (1.74 to 3.68) and 1.95 (1.33 to 2.85), respectively.

Conclusions: HIV infection was significantly associated with increased risks of PTB and LBW in Chinese pregnant women. Future studies should focus on investigating the mechanisms underlying the association between HIV infection and adverse birth outcomes, and on identifying strategies to reduce the incidence of PTB and LBW in pregnant women living with HIV.

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References

Xiao P, Zhou Y, Chen Y, Yang M, Song X, Shi Y . Association between maternal HIV infection and low birth weight and prematurity: a meta-analysis of cohort studies. BMC Pregnancy Childbirth. 2015; 15:246. PMC: 4599647. DOI: 10.1186/s12884-015-0684-z. View

Slattery M, Morrison J . Preterm delivery. Lancet. 2002; 360(9344):1489-97. DOI: 10.1016/S0140-6736(02)11476-0. View

Short C, Quinlan R, Wang X, Preda V, Smith A, Marchesi J . Vaginal Microbiota, Genital Inflammation and Extracellular Matrix Remodelling Collagenase: MMP-9 in Pregnant Women With HIV, a Potential Preterm Birth Mechanism Warranting Further Exploration. Front Cell Infect Microbiol. 2021; 11:750103. PMC: 8667959. DOI: 10.3389/fcimb.2021.750103. View

McCormick M . The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med. 1985; 312(2):82-90. DOI: 10.1056/NEJM198501103120204. View

van der Merwe K, Hoffman R, Black V, Chersich M, Coovadia A, Rees H . Birth outcomes in South African women receiving highly active antiretroviral therapy: a retrospective observational study. J Int AIDS Soc. 2011; 14:42. PMC: 3163172. DOI: 10.1186/1758-2652-14-42. View

Wang X, Wang Q, Wang C, Zhang T, Li Z, Ma Z . Prevention of Mother-To-Child Transmission of HIV - China, 2011-2020. China CDC Wkly. 2021; 3(48):1018-1021. PMC: 8633548. DOI: 10.46234/ccdcw2021.248. View

. Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019. Lancet HIV. 2021; 8(10):e633-e651. PMC: 8491452. DOI: 10.1016/S2352-3018(21)00152-1. View

Arab K, Spence A, Czuzoj-Shulman N, Abenhaim H . Pregnancy outcomes in HIV-positive women: a retrospective cohort study. Arch Gynecol Obstet. 2017; 295(3):599-606. DOI: 10.1007/s00404-016-4271-y. View

Li H, Zheng J, Huang G, Xiao J, Wang H, Yang M . [Prevalence and associated risk factors on preterm birth, low birth weight, and small for gestational age among HIV-infected pregnant women in Hunan province, 2011-2017]. Zhonghua Liu Xing Bing Xue Za Zhi. 2018; 39(10):1368-1374. DOI: 10.3760/cma.j.issn.0254-6450.2018.10.015. View

10.

Townsend C, Byrne L, Cortina-Borja M, Thorne C, de Ruiter A, Lyall H . Earlier initiation of ART and further decline in mother-to-child HIV transmission rates, 2000-2011. AIDS. 2014; 28(7):1049-57. DOI: 10.1097/QAD.0000000000000212. View

11.

Lopez M, Figueras F, Hernandez S, Lonca M, Garcia R, Palacio M . Association of HIV infection with spontaneous and iatrogenic preterm delivery: effect of HAART. AIDS. 2011; 26(1):37-43. DOI: 10.1097/QAD.0b013e32834db300. View

12.

Mocroft A, Ledergerber B, Katlama C, Kirk O, Reiss P, dArminio Monforte A . Decline in the AIDS and death rates in the EuroSIDA study: an observational study. Lancet. 2003; 362(9377):22-9. DOI: 10.1016/s0140-6736(03)13802-0. View

13.

Habib N, Daltveit A, Bergsjo P, Shao J, Oneko O, Lie R . Maternal HIV status and pregnancy outcomes in northeastern Tanzania: a registry-based study. BJOG. 2008; 115(5):616-24. DOI: 10.1111/j.1471-0528.2008.01672.x. View

14.

Dadabhai S, Gadama L, Chamanga R, Kawalazira R, Katumbi C, Makanani B . Pregnancy Outcomes in the Era of Universal Antiretroviral Treatment in Sub-Saharan Africa (POISE Study). J Acquir Immune Defic Syndr. 2018; 80(1):7-14. PMC: 6289692. DOI: 10.1097/QAI.0000000000001875. View

15.

Conroy A, McDonald C, Gamble J, Olwoch P, Natureeba P, Cohan D . Altered angiogenesis as a common mechanism underlying preterm birth, small for gestational age, and stillbirth in women living with HIV. Am J Obstet Gynecol. 2017; 217(6):684.e1-684.e17. PMC: 5723571. DOI: 10.1016/j.ajog.2017.10.003. View

16.

Wedi C, Kirtley S, Hopewell S, Corrigan R, Kennedy S, Hemelaar J . Perinatal outcomes associated with maternal HIV infection: a systematic review and meta-analysis. Lancet HIV. 2016; 3(1):e33-48. DOI: 10.1016/S2352-3018(15)00207-6. View

17.

Mdletshe N, Thobakgale C, Malaba T, Madlala H, Myer L, Muema D . Low Immune Activation in Early Pregnancy Is Associated With Preterm But Not Small-for-gestational-age Delivery in Women Infected With Human Immunodeficiency Virus Initiating Antiretroviral Therapy in Pregnancy: A Prematurity Immunology in.... Clin Infect Dis. 2021; 73(12):2205-2216. PMC: 8677566. DOI: 10.1093/cid/ciab151. View

18.

Mugo C, Nduati R, Osoro E, Nyawanda B, Mirieri H, Hunsperger E . Comparable Pregnancy Outcomes for HIV-Uninfected and HIV-Infected Women on Antiretroviral Treatment in Kenya. J Infect Dis. 2022; 226(4):678-686. PMC: 10155227. DOI: 10.1093/infdis/jiac128. View

19.

Malaba T, Phillips T, le Roux S, Brittain K, Zerbe A, Petro G . Antiretroviral therapy use during pregnancy and adverse birth outcomes in South African women. Int J Epidemiol. 2017; 46(5):1678-1689. PMC: 5837407. DOI: 10.1093/ije/dyx136. View

20.

Patil S, Bhosale R, Sambarey P, Gupte N, Suryavanshi N, Sastry J . Impact of maternal human immunodeficiency virus infection on pregnancy and birth outcomes in Pune, India. AIDS Care. 2011; 23(12):1562-9. DOI: 10.1080/09540121.2011.579948. View