Association of low CD4 cell count and intrauterine growth retardation in Thailand.
OBJECTIVE
Each year, intrauterine growth retardation (IUGR) affects 20-30 million neonates worldwide, mostly in resource-limited settings. Increased perinatal and infant mortality has been associated with IUGR. Some studies have suggested that HIV infection could increase the risk of IUGR. To confirm this hypothesis, we examined the association between HIV-related factors and the risk of IUGR in Thailand.


METHODS
Data from a cohort of 1436 HIV-infected pregnant women enrolled in the "Perinatal HIV Prevention Trial-1", a clinical trial conducted from 1997 to 1999 in Thailand, were analyzed using a logistic regression, adjusting for risk factors usually associated with IUGR.


RESULTS
The rate of IUGR was 7.6%. Adjusting for a short maternal height, low body mass index, small weight gain during pregnancy, and infant female sex, a low maternal CD4 percentage was independently associated with IUGR (odds ratio 0.96, per 1% increment, 95% confidence interval 0.93 to 0.99, P = 0.03).


CONCLUSIONS
The current World Health Organization recommendation to initiate combination antiretroviral therapy for immunocompromised women as early as possible during pregnancy for their own health and for the prevention of HIV mother-to-child transmission is likely to also decrease the incidence of IUGR. Encouraging immunocompromised HIV-infected women who plan to become pregnant to wait until immune restoration has been achieved may help to reduce the risk of IUGR.
Cailhol
Johann
J
Institut de Recherche pour le Développement, Paris, France (UMI 174).
Jourdain
Gonzague
G
Coeur
Sophie Le
SL
Traisathit
Patrinee
P
Boonrod
Kamol
K
Prommas
Sinart
S
Putiyanun
Chaiwat
C
Kanjanasing
Annop
A
Lallemant
Marc
M
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology*