title: Trends in live birth rates and adverse neonatal outcomes among HIV-positive women in Ontario, Canada, 2002-2009: a descriptive population-based study.
abstract: To characterise trends in live birth rates, adverse neonatal outcomes and socio-demographic characteristics of pregnant women with diagnosed HIV between the ages of 18 and 49 in Ontario, Canada from 1 April 2002 to 31 March 2010, we conducted a population-based study. Utilising linked administrative healthcare databases we used generalised estimating equations to characterise secular trends and examine the association between live births and socio-demographic characteristics, including age, region of birth and neighbourhood income quintile. Between 2002/2003 and 2009/2010, there were 551 live births during 15,610 person-years of follow-up. The proportion of HIV-positive mothers originally from Africa or the Caribbean increased from 26.7% to 51.6% over the study period. The risk of pre-term (risk ratio 2.13, 95% confidence interval 1.74 to 2.61) and small for gestational age births (risk ratio 1.53, 95% confidence interval 1.20 to 1.94) was higher in women with HIV compared with provincial estimates for these outcomes. Women with HIV have rates of pre-term and small for gestational age births that exceed provincial estimates for these outcomes. Further research is required to identify factors mediating these disparities that are amenable to pre-natal risk reduction initiatives.
authors.affiliation: Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Canada The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada Institute for Clinical Evaluative Sciences, Toronto, Canada tantoniou@smh.ca.
authors.forename: Tony
authors.initials: T
authors.lastname: Antoniou
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
authors.forename: Brandon
authors.initials: B
authors.lastname: Zagorski
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Macdonald
authors.affiliation: The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada Institute for Clinical Evaluative Sciences, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada Department of Medicine, University of Toronto, Toronto, Canada Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON Canada.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Bayoumi
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada Toronto General Research Institute, University Health Network, Toronto, ON Canada Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Raboud
authors.affiliation: Children's Hospital of Eastern Ontario, Ottawa, ON Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Brophy
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, ON Canada.
authors.forename: Khatundi-Irene
authors.initials: KI
authors.lastname: Masinde
authors.affiliation: Women's Health in Women's Hands, Toronto, ON Canada.
authors.forename: Wangari E
authors.initials: WE
authors.lastname: Tharao
authors.affiliation: The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON Canada Department of Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto, ON Canada.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Yudin
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Ryan
authors.initials: R
authors.lastname: Ng
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada Department of Medicine, University of Toronto, Toronto, Canada Women's College Research Institute, Women's College Hospital, Toronto, ON Canada.
authors.forename: Mona R
authors.initials: MR
authors.lastname: Loutfy
authors.affiliation: Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Canada The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada Institute for Clinical Evaluative Sciences, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON Canada Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents; D001723:Birth Rate / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D016015:Logistic Models; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology*; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: AIDS; Canada; HIV; infectious; pre-term labour; pregnancy complications; pregnancy outcome; small for gestational age; women