title: Correlates and outcomes of preterm birth, low birth weight, and small for gestational age in HIV-exposed uninfected infants.
abstract: BACKGROUND
  Preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA) contribute to neonatal mortality. Maternal HIV-1 infection has been associated with an increased risk of PTB, but mechanisms underlying this association are undefined. We describe correlates and outcomes of PTB, LBW, and SGA in HIV-exposed uninfected infants.
  
  
  METHODS
  This was a retrospective analysis of cohort study. Between 1999-2002, pregnant, HIV-infected women were enrolled into an HIV-1 transmission study. Logistic regression was used to identify correlates of PTB, LBW and SGA in HIV-negative, spontaneous singleton deliveries. Associations between birth outcomes and mortality were measured using survival analyses.
  
  
  RESULTS
  In multivariable models, maternal plasma (OR = 2.1, 95% CI = 1.1-3.8) and cervical HIV-1 RNA levels (OR = 1.6, 95% CI = 1.1-2.4), and CD4 < 15% (OR = 2.4, 95% CI = 1.0-5.6) were associated with increased odds of PTB. Abnormal vaginal discharge and cervical polymorphonuclear leukocytes were also associated with PTB. Cervical HIV-1 RNA level (OR = 2.4, 95% CI = 1.5-6.7) was associated with an increased odds of LBW, while increasing parity (OR = 0.46, 95% CI = 0.24-0.88) was associated with reduced odds. Higher maternal body mass index (OR = 0.75, 95% CI = 0.61-0.92) was associated with a reduced odds of SGA, while bacterial vaginosis was associated with >3-fold increased odds (OR = 3.2, 95% CI = 1.4-7.4). PTB, LBW, and SGA were each associated with a >6-fold increased risk of neonatal death, and a >2-fold increased rate of infant mortality within the first year.
  
  
  CONCLUSIONS
  Maternal plasma and cervical HIV-1 RNA load, and genital infections may be important risk factors for PTB in HIV-exposed uninfected infants. PTB, LBW, and SGA are associated with increased neonatal and infant mortality in HIV-exposed uninfected infants.
authors.affiliation: Department of Global Health, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA 98104, USA. jslyker@uw.edu.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Slyker
authors.forename: Janna
authors.initials: J
authors.lastname: Patterson
authors.forename: Gwen
authors.initials: G
authors.lastname: Ambler
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Maleche-Obimbo
authors.forename: Rose
authors.initials: R
authors.lastname: Bosire
authors.forename: Dorothy
authors.initials: D
authors.lastname: Mbori-Ngacha
authors.forename: Carey
authors.initials: C
authors.lastname: Farquhar
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
mesh_terms: D000328:Adult; D001724:Birth Weight; D015992:Body Mass Index; D002584:Cervix Uteri / Q000737:chemistry* / Q000166:cytology; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D009504:Neutrophils; D010298:Parity; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000453:epidemiology* / Q000821:virology; D047928:Premature Birth / Q000453:epidemiology*; D012367:RNA, Viral / Q000032:analysis / Q000097:blood*; D012189:Retrospective Studies; D012307:Risk Factors; D019522:Vaginal Discharge / Q000453:epidemiology; D016585:Vaginosis, Bacterial / Q000453:epidemiology; D055815:Young Adult
chemical_list: D012367:RNA, Viral