title: Demographic and management trends among HIV-positive pregnant women over 10 years at one Canadian urban hospital.
abstract: OBJECTIVE
  There is limited information about changing trends in the management of HIV-positive pregnancies in Canada as Canadian and international guidelines are updated. We reviewed the experience over a 10-year period of one Canadian urban hospital with regard to trends in the demographics and management of HIV-positive pregnant women.
  
  
  METHODS
  We performed a retrospective chart review of all HIV-positive pregnant women delivering between March 2000 and March 2010. Demographic, pregnancy, and intrapartum data were collected and analyzed.
  
  
  RESULTS
  During the study period, there were 141 singleton pregnancies in HIV-positive women. The mean age of the cohort was 30.4 years. The number of women seen increased significantly over time (P < 0.001), with 63% of cases in care from 2007 to 2010. Most women were of African descent and had recently immigrated to Canada. There was a statistically significant trend towards increasing numbers of Afro-Caribbean women over the study period (P = 0.03). Only 4% reported illicit drug use in their current pregnancy. Although the majority of women had a known diagnosis of HIV before pregnancy, 30 (22.4%) had the diagnosis made on antepartum testing. Most women were compliant with their highly active antiretroviral therapy (94.3%) and had undetectable viral loads documented at the time of delivery (76.4%). A significant shift towards increased use of protease inhibitor antiretovirals in pregnancy was noted over time (P < 0.001). All neonates received zidovudine after delivery. There were no cases of vertical HIV transmission.
  
  
  CONCLUSIONS
  Our review documented increasing numbers of HIV-positive pregnant women over the past 10 years. The majority of these women were healthy with well-managed disease, and had favourable pregnancy outcomes. There were no infected children born during the study period.
authors: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors: Daniela
authors: D
authors: Caprara
authors: Department of Obstetrics and Gynaecology, St. Michael's Hospital, Toronto ON.
authors: Rajiv
authors: R
authors: Shah
authors: Department of Obstetrics and Gynaecology, St. Michael's Hospital, Toronto ON.
authors: S Jay
authors: SJ
authors: MacGillivray
authors: Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto ON.
authors: Marcelo
authors: M
authors: Urquia
authors: Department of Obstetrics and Gynaecology, St. Michael's Hospital, Toronto ON.
authors: Mark H
authors: MH
authors: Yudin
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000208:ethnology; D019380:Anti-HIV Agents / Q000008:administration & dosage; D023241:Antiretroviral Therapy, Highly Active; D002170:Canada; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D019562:Viral Load; D015215:Zidovudine / Q000008:administration & dosage
chemical_list: D019380:Anti-HIV Agents; D015215:Zidovudine
keywords: HIV; patient care; prenatal