Obstetric and newborn outcomes in a cohort of HIV-infected pregnant women: a report of the women and infants transmission study.
OBJECTIVE
To determine obstetric and neonatal outcomes in a cohort of HIV-infected pregnant women and to assess whether HIV-related immunosuppression increases the risk of adverse outcomes of pregnancy.


METHODS
Between 1989 and 1994, interview, physical examination, laboratory, and medical record data were prospectively collected from HIV-infected pregnant women and on their newborns. Factors associated with adverse pregnancy outcome and HIV disease status were correlated with pregnancy outcome using logistic regression analysis.


RESULTS
634 women delivered after 24 weeks of gestation. Preterm birth, low birth weight, and small-for-gestational-age neonates occurred in 20.5%, 18.9%, and 24.0% of pregnancies, respectively. Factors associated with low birth weight were CD4 percentage <14%, history of adverse pregnancy outcome, pediatric HIV infection, bleeding during pregnancy, and Trichomonas infection. Preterm birth was associated with CD4 percentage <14%, a history of adverse pregnancy outcome, and bleeding during pregnancy. Being small for gestational age was associated with maternal hard drug use during pregnancy, Trichomonas infection, history of adverse pregnancy outcome, and hypertension.


CONCLUSIONS
Adverse pregnancy outcomes are common for HIV-infected women and are associated with low maternal CD4 percentage and pediatric HIV infection. Preterm birth, low birth weight, and small-for-gestational-age ranking, however, are also associated with previously recognized sociodemographic and obstetric factors that are not unique to HIV infection.
Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20982-1862, USA. Strattop@cc1.nichd.nih.gov
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P
Stratton
R E
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Tuomala
R
R
Abboud
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E
Rodriguez
K
K
Rich
J
J
Pitt
C
C
Diaz
H
H
Hammill
H
H
Minkoff
D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000635:transmission*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D018445:Infectious Disease Transmission, Vertical; D015999:Multivariate Analysis; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors