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Predictors of adverse pregnancy outcomes in women infected with HIV in L atin A merica and the C aribbean: a cohort study
Author(s) -
Kreitchmann R,
Li SX,
Melo VH,
Fernandes Coelho D,
Watts DH,
Joao E,
Coutinho CM,
Alarcon JO,
Siberry GK
Publication year - 2014
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12680
Subject(s) - medicine , pregnancy , odds ratio , obstetrics , small for gestational age , confidence interval , gestational age , premature birth , body mass index , logistic regression , population , cohort , prospective cohort study , cohort study , adverse effect , genetics , biology , environmental health
Objective To examine maternal characteristics associated with adverse pregnancy outcomes among women infected with HIV . Design Prospective cohort study. Setting Multiple sites in L atin A merica and the C aribbean. Population Women infected with HIV enrolled in the P erinatal (2002–2007) and the L ongitudinal S tudy in L atin A merican C ountries ( LILAC ; 2008–2012) studies of the E unice K ennedy S hriver N ational I nstitute of C hild H ealth and H uman D evelopment ( NICHD ) I nternational S ite D evelopment I nitiative ( NISDI ). Methods Frequencies of adverse pregnancy outcomes assessed among pregnancies. Risk factors investigated by logistic regression analysis. Main outcome measures Adverse pregnancy outcomes, including preterm delivery ( PT ), low birthweight ( LBW ), small for gestational age ( SGA ), stillbirth ( SB ), and neonatal death. Results Among 1512 women, 1.9% (95% confidence interval, 95% CI , 1.3–2.7) of singleton pregnancies resulted in a stillbirth and 32.9% (95% CI 30.6–35.4) had at least one adverse pregnancy outcome. Of 1483 singleton live births, 19.8% (95% CI 17.8–21.9) were PT , 14.2% (95% CI 12.5–16.1) were LBW , 12.6% (95% CI 10.9–14.4) were SGA , and 0.4% (95% CI 0.2–0.9) of infants died within 28 days of birth. Multivariable logistic regression modelling indicated that the following risk factors increased the probability of having one or more adverse pregnancy outcomes: lower maternal body mass index at delivery (odds ratio, OR , 2.2; 95% CI 1.4–3.5), hospitalisation during pregnancy ( OR 3.3; 95% CI 2.0–5.3), hypertension during pregnancy ( OR 2.7; 95% CI 1.5–4.8), antiretroviral use at conception ( OR 1.4; 95% CI 1.0–1.9), and tobacco use during pregnancy ( OR 1.7; 95% CI 1.3–2.2). The results of fitting multivariable logistic regression models for PT , LBW , SGA , and SB are also reported. Conclusions Women infected with HIV had a relatively high occurrence of adverse pregnancy outcomes, and some maternal risk factors were associated with these adverse pregnancy outcomes. Interventions targeting modifiable risk factors should be evaluated further.