title: Risk factors for very preterm delivery and delivery of very-small-for-gestational-age infants among HIV-exposed and HIV-unexposed infants in Botswana.
abstract: OBJECTIVE
  To evaluate risk factors for very preterm delivery (VPTD) and very-small-for-gestational-age (VSGA) births in a country with a high HIV prevalence.
  
  
  METHODS
  Obstetric records at 6 hospitals across Botswana were reviewed at delivery; VPTD was defined as birth before 32 weeks of pregnancy and VSGA as birth weight below the 3rd percentile for Botswana-specific norms.
  
  
  RESULTS
  Of 16219 live births born after 26 weeks of pregnancy, 701 (4.3%) were delivered very preterm and 607 (3.7%) were VSGA; 4347 (28.4%) were documented as HIV-exposed. In a multivariable analysis, HIV infection and hypertension during pregnancy were associated with a VPTD (adjusted odds ratio [AOR]: HIV 1.65, hypertension 1.75) and a VSGA birth (AOR: HIV infection 1.90, hypertension 3.44). Among HIV-infected women, the continuation of highly active antiretroviral therapy (HAART) from before conception was associated with a VSGA birth (AOR 1.75) but not with a VPTD (AOR 0.78). In a secondary analysis, HAART continuation was associated with hypertension during pregnancy (AOR 1.34).
  
  
  CONCLUSIONS
  Hypertension and HIV infection were risk factors for a VPTD and a VSGA birth. Continuation of HAART from before conception was associated with a VSGA birth but not with a VPTD.
authors.affiliation: University of Miami Miller School of Medicine, Miami, USA.
authors.forename: Natasha
authors.initials: N
authors.lastname: Parekh
authors.forename: Heather
authors.initials: H
authors.lastname: Ribaudo
authors.forename: Sajini
authors.initials: S
authors.lastname: Souda
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chen
authors.forename: Mompati
authors.initials: M
authors.lastname: Mmalane
authors.forename: Kathleen
authors.initials: K
authors.lastname: Powis
authors.forename: Max
authors.initials: M
authors.lastname: Essex
authors.forename: Joseph
authors.initials: J
authors.lastname: Makhema
authors.forename: Roger L
authors.initials: RL
authors.lastname: Shapiro
mesh_terms: D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods; D001902:Botswana / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000209:etiology; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D015999:Multivariate Analysis; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology*; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology* / Q000821:virology; D012307:Risk Factors; D055815:Young Adult