title: Rate, predictors, and consequences of late antenatal booking in a national cohort study of pregnant women with HIV in Italy.
abstract: OBJECTIVE
  To evaluate the prevalence and consequences of late antenatal booking (13 or more weeks gestation) in a national observational study of pregnant women with HIV.
  
  
  METHODS
  The clinical and demographic characteristics associated with late booking were evaluated in univariate analyses using the Mann-Whitney U test for quantitative data and the chi-square test for categorical data. The associations that were found were re-evaluated in multivariable logistic regression models. Main outcomes were preterm delivery, low birthweight, nonelective cesarean section, birth defects, undetectable (<50 copies/mL) HIV plasma viral load at third trimester, delivery complications, and gender-adjusted and gestational age-adjusted Z scores for birthweight.
  
  
  RESULTS
  Rate of late booking among 1,643 pregnancies was 32.9%. This condition was associated with younger age, African provenance, diagnosis of HIV during pregnancy, and less antiretroviral exposure. Undetectable HIV RNA at third trimester and preterm delivery were significantly more prevalent with earlier booking (67.1% vs 46.3%, P < .001, and 23.2% vs 17.6, P = .010, respectively), whereas complications of delivery were more common with late booking (8.2% vs 5.0%, P = .013). Multivariable analyses confirmed an independent role of late booking in predicting detectable HIV RNA at third trimester (adjusted odds ratio [AOR], 1.7; 95% CI, 1.3-2.3; P < .001) and delivery complications (AOR, 1.8; 95% CI, 1.2-2.8; P = .005).
  
  
  CONCLUSIONS
  Late antenatal booking was associated with detectable HIV RNA in late pregnancy and with complications of delivery. Measures should be taken to ensure an earlier entry into antenatal care, particularly for African women, and to facilitate access to counselling and antenatal services. These measures can significantly improve pregnancy management and reduce morbidity and complications in pregnant women with HIV.
authors.affiliation: Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Floridia
authors.affiliation: I.N.M.I. Lazzaro Spallanzani, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Pinnetti
authors.affiliation: Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Ravizza
authors.affiliation: Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Frisina
authors.affiliation: Department of Obstetrics and Gynaecology, Luigi Sacco Hospital, University of Milan, Milan, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Cetin
authors.affiliation: Department of Pediatrics, University of Padova, Padova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Fiscon
authors.affiliation: Department of Obstetrics and Gynaecology, University Federico II of Naples, Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Sansone
authors.affiliation: Department of Infectious Diseases and Hepatology, Azienda Ospedaliera di Parma, Parma, Italy.
authors.forename: A Degli
authors.initials: AD
authors.lastname: Antoni
authors.affiliation: Department of Medical Specialties, Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Guaraldi
authors.affiliation: Department of Obstetrics and Gynaecology, University of Bari and Policlinic Hospital, Bari, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Vimercati
authors.affiliation: University of Bologna and St. Orsola Malpighi General Hospital, Bologna, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Guerra
authors.affiliation: Unit of Infectious Diseases, Pescara General Hospital, Pescara, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Placido
authors.affiliation: Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Dalzero
authors.affiliation: Department of Infectious Diseases, Catholic University, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Tamburrini
mesh_terms: D000328:Adult; D000349:Africa / Q000208:ethnology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D047928:Premature Birth; D012367:RNA, Viral / Q000097:blood
chemical_list: D012367:RNA, Viral
keywords: African ethnicity; HIV; HIV-RNA; antenatal booking; delivery complications; pregnancy; preterm delivery