title: Pregnancy outcomes in HIV-positive women: a retrospective cohort study.
abstract: OBJECTIVE
  In the United States, an estimated 8500 HIV (human immunodeficiency virus) positive women gave birth in 2014. This rate appears to be increasing annually. Our objective is to examine obstetrical outcomes of pregnancy among HIV-positive women.
  
  
  METHODS
  A population-based cohort study was conducted using the Nationwide Inpatient Sample database (2003-2011) from the United States. Pregnant HIV-positive women were identified and compared to pregnant women without HIV. Multivariate logistic regression was used to estimate the adjusted effect of HIV status on obstetrical and neonatal outcomes.
  
  
  RESULTS
  Among 7,772,999 births over the study period, 1997 were in HIV-positive women (an incidence of 25.7/100,000 births). HIV-infected patients had greater frequency of pre-existing diabetes and chronic hypertension, and use of cigarettes, drugs, and alcohol during pregnancy (p < 0.001). Upon adjustment for baseline characteristics, HIV-infected women had greater likelihood of antenatal complications: preterm premature rupture of membranes (OR 1.35, 95% CI 1.14-1.60) and urinary tract infections (OR 3.02, 95% CI 2.40-3.81). Delivery and postpartum complications were also increased among HIV-infected women: cesarean delivery (OR 3.06, 95% CI 2.79-3.36), postpartum sepsis (OR 8.05, 95% CI 5.44-11.90), venous thromboembolism (OR 2.21, 95% CI 1.46-3.33), blood transfusions (OR 3.67, 95% CI 3.01-4.49), postpartum infection (OR 3.00, 95% CI 2.37-3.80), and maternal mortality (OR 21.52, 95% CI 12.96-35.72). Neonates born to these mothers were at higher risk of prematurity and intrauterine growth restriction.
  
  
  CONCLUSIONS
  Pregnancy in HIV-infected women is associated with adverse maternal and newborn complications. Pregnant HIV-positive women should be followed in high-risk healthcare centers.
authors.affiliation: Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Pav H, Room 325, 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada.
authors.forename: Kholoud
authors.initials: K
authors.lastname: Arab
authors.affiliation: Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada.
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Spence
authors.affiliation: Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Czuzoj-Shulman
authors.affiliation: Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Pav H, Room 325, 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada. haim.abenhaim@gmail.com.|Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada. haim.abenhaim@gmail.com.
authors.forename: Haim A
authors.initials: HA
authors.lastname: Abenhaim
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D008428:Maternal Mortality; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology; D011256:Pregnancy Outcome; D012189:Retrospective Studies
keywords: Anti-retroviral treatment; Human immunodeficiency virus; Obstetrical outcomes