Increased risk of pre-eclampsia and fetal death in HIV-infected pregnant women receiving highly active antiretroviral therapy.
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.
Suy
Anna
A
Obstetric and Gynecological Service, Hospital Clinic of the Institute of Biomedical Investigations, August Pi i Sunyer Hospital, University of Barcelona, Barcelona, Spain.
Martínez
Esteban
E
Coll
Oriol
O
Lonca
Montserrat
M
Palacio
Montserrat
M
de Lazzari
Elisa
E
Larrousse
María
M
Milinkovic
Ana
A
Hernández
Sandra
S
Blanco
José L
JL
Mallolas
Josep
J
León
Agathe
A
Vanrell
Juan A
JA
Gatell
José M
JM
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
D019040:E-Selectin; D007328:Insulin; D019007:P-Selectin