Preterm birth and fetal growth restriction in HIV-infected Brazilian pregnant women.
BACKGROUND
Maternal HIV infection and related co-morbidities may have two outstanding consequences to fetal health: mother-to-child transmission (MTCT) and adverse perinatal outcomes. After Brazilian success in reducing MTCT, the attention must now be diverted to the potentially increased risk for preterm birth (PTB) and intrauterine fetal growth restriction (IUGR).


OBJECTIVE
To determine the prevalence of PTB and IUGR in low income, antiretroviral users, publicly assisted, HIV-infected women and to verify its relation to the HIV infection stage.


METHODS
Out of 250 deliveries from HIV-infected mothers that delivered at a tertiary public university hospital in the city of Vitória, state of Espírito Santo, Southeastern Brazil, from November 2001 to May 2012, 74 single pregnancies were selected for study, with ultrasound validated gestational age (GA) and data on birth dimensions: fetal weight (FW), birth length (BL), head and abdominal circumferences (HC, AC). The data were extracted from clinical and pathological records, and the outcomes summarized as proportions of preterm birth (PTB, < 37 weeks), low birth weight (LBW, < 2500 g) and small (SGA), adequate (AGA) and large (LGA) for GA, defined as having a value below, between or beyond the ± 1.28 z/GA score, the usual clinical cut-off to demarcate the 10th and 90th percentiles.


RESULTS
PTB was observed in 17.5%, LBW in 20.2% and SGA FW, BL, HC and AC in 16.2%, 19.1%, 13.8%, and 17.4% respectively. The proportions in HIV-only and AIDS cases were: PTB: 5.9 versus 27.5%, LBW: 14.7% versus 25.0%, SGA BW: 17.6% versus 15.0%, BL: 6.0% versus 30.0%, HC: 9.0% versus 17.9%, and AC: 13.3% versus 21.2%; only SGA BL attained a significant difference. Out of 15 cases of LBW, eight (53.3%) were preterm only, four (26.7%) were SGA only, and three (20.0%) were both PTB and SGA cases. A concomitant presence of, at least, two SGA dimensions in the same fetus was frequent.


CONCLUSIONS
The proportions of preterm birth and low birth weight were higher than the local and Brazilian prevalence and a trend was observed for higher proportions of SGA fetal dimensions than the expected population distribution in this small casuistry of newborn from the HIV-infected, low income, antiretroviral users, and publicly assisted pregnant women. A trend for higher prevalence of PTB, LBW and SGA fetal dimensions was also observed in infants born to mothers with AIDS compared to HIV-infected mothers without AIDS.
Cassiano Antonio Moraes University Hospital, Federal University of Espírito Santo, Brasil.
Helena Lucia Barroso
HL
Dos Reis
Health Sciences Centre, Federal University of Espírito Santo, Brasil.
Karina da Silva
Kda S
Araujo
Health Sciences Centre, Federal University of Espírito Santo, Brasil.
Lilian Paula
LP
Ribeiro
Health Sciences Centre, Federal University of Espírito Santo, Brasil.
Daniel Ribeiro
DR
Da Rocha
Health Sciences Centre, Federal University of Espírito Santo, Brasil.
Drielli Petri
DP
Rosato
Materno-fetal Health Postgraduate Course, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil.
Mauro Romero Leal
MR
Passos
Cassiano Antonio Moraes University Hospital, Vitória, Espírito Santo, Brazil.
Paulo Roberto
PR
Merçon De Vargas
D000328:Adult; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology / Q000209:etiology*; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors