title: Increased risk of pre-eclampsia and fetal death in HIV-infected pregnant women receiving highly active antiretroviral therapy.
abstract: BACKGROUND
  Pre-eclampsia and/or fetal death have increased sharply in HIV-infected pregnant women receiving HAART.
  
  
  METHODS
  The occurrence of pre-eclampsia or fetal death was analysed in women who delivered after at least 22 weeks of gestation for all women (January 2001 until July 2003) and for HIV-infected women (November 1985 until July 2003).
  
  
  RESULTS
  In 2001, 2002 and 2003, the rates per 1000 deliveries of pre-eclampsia and fetal death, respectively, remained stable in all pregnant women at 25.4, 31.9 and 27.7 (P = 0.48) and 4.8, 5.8, and 5.0 (P = 0.89) (n = 8768). In 1985-2000 (n = 390) to 2001-2003 (n = 82), rates per 1000 deliveries in HIV-infected women rose from 0.0 to 109.8 (P < 0.001) for pre-eclampsia and from 7.7 to 61.0 (P < 0.001) for fetal death. In all pregnant women, factors associated with pre-eclampsia or fetal death were multiple gestation [adjusted odds ratio (OR) 3.6; 95% confidence interval (CI), 2.3-5.6; P < 0.001], HIV infection (adjusted OR, 4.9; 95% CI, 2.4-10.1; P < 0.001), multiparity (adjusted OR, 0.76; 95% CI, 0.58-0.98; P = 0.040) and tobacco smoking (adjusted OR, 0.65; 95% CI, 0.46-0.90; P = 0.010). The use of HAART prior to pregnancy (adjusted OR, 5.6; 95% CI, 1.7-18.1; P = 0.004) and tobacco smoking (adjusted OR, 0.183; 95% CI, 0.054-0.627; P = 0.007) were risk factors in HIV-infected women.
  
  
  CONCLUSIONS
  HIV infection treated with HAART prior to pregnancy was associated with a significantly higher risk for pre-eclampsia and fetal death.
authors.affiliation: Obstetric and Gynecological Service, Hospital Clinic of the Institute of Biomedical Investigations, August Pi i Sunyer Hospital, University of Barcelona, Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Suy
authors.forename: Esteban
authors.initials: E
authors.lastname: Martínez
authors.forename: Oriol
authors.initials: O
authors.lastname: Coll
authors.forename: Montserrat
authors.initials: M
authors.lastname: Lonca
authors.forename: Montserrat
authors.initials: M
authors.lastname: Palacio
authors.forename: Elisa
authors.initials: E
authors.lastname: de Lazzari
authors.forename: María
authors.initials: M
authors.lastname: Larrousse
authors.forename: Ana
authors.initials: A
authors.lastname: Milinkovic
authors.forename: Sandra
authors.initials: S
authors.lastname: Hernández
authors.forename: José L
authors.initials: JL
authors.lastname: Blanco
authors.forename: Josep
authors.initials: J
authors.lastname: Mallolas
authors.forename: Agathe
authors.initials: A
authors.lastname: León
authors.forename: Juan A
authors.initials: JA
authors.lastname: Vanrell
authors.forename: José M
authors.initials: JM
authors.lastname: Gatell
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D019040:E-Selectin / Q000097:blood; D005260:Female; D005313:Fetal Death / Q000139:chemically induced / Q000209:etiology*; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007328:Insulin / Q000097:blood; D019007:P-Selectin / Q000097:blood; D010298:Parity; D011225:Pre-Eclampsia / Q000139:chemically induced / Q000209:etiology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
chemical_list: D019040:E-Selectin; D007328:Insulin; D019007:P-Selectin