title: Maternal placental syndromes among women living with HIV in Ontario: a population-based study.
abstract: BACKGROUND
  Maternal placental syndromes are associated with adverse fetal outcomes and maternal cardiovascular disease. However, whether HIV infection increases the risk of maternal placental syndromes is unknown. Our objective was to compare the risk of maternal placental syndromes between women living with and without HIV infection in Ontario.
  
  
  METHODS
  We conducted a population-based study using health administrative data from Ontario. We identified all pregnancies resulting in a live birth between Apr. 1, 2002, and Mar. 31, 2011; we identified women living with HIV using a validated case-finding algorithm. Our primary composite outcome was maternal placental syndromes, defined as a diagnosis of preeclampsia, eclampsia, placental abruption or placental infarction. We used generalized estimating equations with a logit link function to derive adjusted odds ratios (AORs) and 95% confidence intervals (CI) for the association between HIV infection and maternal placental syndromes.
  
  
  RESULTS
  Data from 1 132 871 pregnancies were available for analysis; 634 (0.06%) of the pregnancies were in women living with HIV. After multivariable adjustment, we found no difference in the risk of maternal placental syndromes between women living with HIV and those without HIV infection (5.8% v. 5.6%; AOR 0.85 [95% CI 0.59-1.21]). An increased risk of maternal placental syndromes was associated with pre-existing diabetes (AOR 1.47 [95% CI 1.39-1.54]), pre-existing hypertension (AOR 4.28 [95% CI 4.15-4.42]) and chronic kidney disease (AOR 1.83 [95% CI 1.61-2.08]).
  
  
  CONCLUSIONS
  Women with HIV are not at increased risk of maternal placental syndromes. Our results underscore the importance of optimizing the management of comorbid illness associated with maternal placental syndromes during the prenatal period for all women, irrespective of HIV status.
authors.affiliation: Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.
authors.forename: Ryan
authors.initials: R
authors.lastname: Ng
authors.affiliation: Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Macdonald
authors.affiliation: Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Yudin
authors.affiliation: Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Bayoumi
authors.affiliation: Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.
authors.forename: Mona R
authors.initials: MR
authors.lastname: Loutfy
authors.affiliation: Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.
authors.forename: Janet
authors.initials: J
authors.lastname: Raboud
authors.affiliation: Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.
authors.forename: Khatundi-Irene
authors.initials: KI
authors.lastname: Masinde
authors.affiliation: Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.
authors.forename: Wangari E
authors.initials: WE
authors.lastname: Tharao
authors.affiliation: Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.
authors.forename: Jason
authors.initials: J
authors.lastname: Brophy
authors.affiliation: Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
authors.affiliation: Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.
authors.forename: Tony
authors.initials: T
authors.lastname: Antoniou