Management and outcomes of pregnancies among women with HIV in Oxford, UK, in 2008-2012.
OBJECTIVE
To evaluate the management and outcomes of pregnancies among women with HIV infection.


METHODS
A retrospective cohort study was undertaken of pregnant women with HIV who delivered at one center in the UK in 2008-2012. Case notes were reviewed and detailed information extracted regarding obstetric and virological management.


RESULTS
Overall, 61 pregnancies were included; 43% (26/60) were unplanned and 39% (22/57) booked late. HIV infection was diagnosed during pregnancy for 32% (19/60); 71% (12/17) were diagnosed after the first trimester. At booking, 47% of women (28/60) were not on treatment, all but one of whom commenced treatment, either for maternal reasons (CD4 count <350 cells per mm(3); 48% [13/27]) or prevention of mother-to-child-transmission (52% [14/27]). Viral load was high (>50 copies per mL) at delivery for 13% of women (8/61). Delivery was by cesarean for 74% [45/61]. One neonate was diagnosed with HIV infection. There were 6 (10%) preterm births, 9 (15%) cases of low birth weight, 11 (18%) small-for-gestational-age neonates, and 1 (2%) stillbirth.


CONCLUSIONS
Better pregnancy planning, earlier booking and HIV diagnosis, and optimal antiretroviral treatment should increase the proportion of women with a low viral load (<50 copies per mL) at delivery, lead to more vaginal deliveries, and further reduce mother-to-child transmission of HIV.
Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
Sarah
S
Montgomery-Taylor
Nuffield Department of Obstetrics and Gynaecology, University of Oxford, The Women's Centre, John Radcliffe Hospital, Oxford, UK; Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK. Electronic address: joris.hemelaar@obs-gyn.ox.ac.uk.
Joris
J
Hemelaar
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002585:Cesarean Section; D005260:Female; D005865:Gestational Age; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D047928:Premature Birth; D012189:Retrospective Studies; D012307:Risk Factors; D050497:Stillbirth; D006113:United Kingdom; D019562:Viral Load; D015215:Zidovudine / Q000008:administration & dosage*
D019380:Anti-HIV Agents; D015215:Zidovudine
Antiretroviral; Birth weight; Gestational age; HIV; Mother-to-child transmission; Pregnancy; Viral load