Adverse outcomes of pregnancy in HIV‐positive women in the era of HAART: a perspective from an outer London centre in the UK

Background Increasing number of women with HIV are choosing to become pregnant as there is dramatic reduction in the risk of vertical transmission. However, management of HIV in pregnancy still poses a variety of challenges and adverse pregnancy outcomes are still common. We aimed to explore the factors associated with adverse outcomes of pregnancy in our HIV cohort. Methods It is a retrospective case note review of all the women attended our unit and had HIV care from 2008–2011. A total of 87 women were followed up. Three women had two pregnancies during the study period. Data collected from Genitourinary Medicine and maternity records were analysed using SPSS program. Results Mean age was 34 yrs ranging from 20–43 yrs. Majority (91%) were of African origin; 67% had HIV subtype C; 26% resistant to one or more class of HIV drugs; 55% had a nadir CD4 fewer than 350; 44% diagnosed at an antenatal setting and 62% were planned pregnancies. Prior to the current pregnancy, these women had 121 children: 5% of the children have HIV and 33% not tested for HIV. Of the partners, 38% have HIV and 73% were aware of their partner's HIV status. None of the children born during the study period were infected with HIV; mean birth weight was 2789 g; there were 3 sets of twins; one still birth and one child died soon after birth. Around 46% were on anti‐retroviral therapy (ART) during conception, 6% had miscarriages and 16% had emergency caesarean sections. At delivery, viral load was detectable in 23%, mainly due to poor adherence (11%) and late presentation (9%). 38% of the women experienced an obstetric complication, premature labour 9%; premature rupture of membranes and gestational diabetes both accounted to 4% whilst 3% had post‐partum haemorrhage. On ART during conception and late HIV diagnosis that is nadir CD4, less than 350 cells were significantly associated (P<0.05) with having a foetal complication such as prematurity 8%, low birth weight 7% or having a foetal abnormality 2.3%. There was no significant association between 1st and 2nd trimester ART exposure and adverse pregnancy outcomes such as prematurity, low birth weight or foetal abnormality. Conclusion Late diagnosis of HIV and ART during conception is significantly associated with adverse outcomes of pregnancy. Widespread HIV testing is essential and has to be extended to non‐traditional settings. In addition, more studies are needed on ART exposure and adverse pregnancy outcomes.