title: Increasing Number and Proportion of Adverse Obstetrical Outcomes among Women Living with HIV in the Ottawa Area: A 20-Year Clinical Case Series.
abstract: Background. The prevalence and associated risks with adverse obstetrical outcomes among women living with HIV are not well measured. The objective of this study was to longitudinally investigate the prevalence and correlates of adverse obstetrical outcomes among women with HIV. Methods. This 20-year (1990-2010) clinical case series assessed the prevalence of adverse obstetrical outcomes among pregnant women with HIV receiving care at The Ottawa Hospital (TOH). General estimating equation modeling was used to identify factors independently associated with adverse obstetrical outcomes, while controlling for year of childbirth clustering. Results. At TOH, there were 127 deliveries among 94 women (1990-2010): 22 preterm births, 9 births with low birth weight, 12 births small for gestational age, and 4 stillbirths. Per year, the odds of adverse obstetrical outcomes increased by 15% (OR: 1.15, 95% CI: 1.03-1.30). Psychiatric illness (AOR: 2.64, 95% CI: 1.12-6.24), teen pregnancy (AOR: 3.35, 95% CI: 1.04-1.46), and recent immigrant status (AOR: 7.24, 95% CI: 1.30-40.28) were the strongest correlates of adverse obstetrical outcomes. Conclusions. The increasing number and proportion of adverse obstetrical outcomes among pregnant women with HIV over the past 20 years highlight the need for social supports and maternal and child health interventions, especially among adolescents, new immigrants, and those with a history of mental illness.
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6; Department of Medicine, Division of Infectious Disease, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6.
authors.forename: Sarah
authors.initials: S
authors.lastname: Buchan
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6; School of Epidemiology, Public Health and Presentation Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6.
authors.forename: Katherine A
authors.identifier: 0000-0002-0766-4294
authors.initials: KA
authors.lastname: Muldoon
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6.
authors.forename: Johanna N
authors.initials: JN
authors.lastname: Spaans
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6; Department of Medicine, Division of Infectious Disease, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6; Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6.
authors.forename: Louise
authors.initials: L
authors.lastname: Balfour
authors.affiliation: Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada K1H 8L1.
authors.forename: Lindy
authors.identifier: 0000-0003-3701-3529
authors.initials: L
authors.lastname: Samson
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6; School of Epidemiology, Public Health and Presentation Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6; Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6.
authors.forename: Mark
authors.identifier: 0000-0003-3700-7997
authors.initials: M
authors.lastname: Walker
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6; Department of Medicine, Division of Infectious Disease, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6; School of Epidemiology, Public Health and Presentation Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6.
authors.forename: D William
authors.identifier: 0000-0002-0090-3539
authors.initials: DW
authors.lastname: Cameron