Open AccessPregnancy outcomes in HIV‐infected women in a German cohort
Author(s) -
Gingelmaier A,
Krznaric I,
Roemer K,
Hertling S,
Usadel S,
Loeffler H,
Steib Bauert M,
Knecht G,
Hanhoff N,
Weizsaecker K
Publication year - 2012
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.15.6.18253
Subject(s) - medicine , pregnancy , gestational age , obstetrics , vaginal delivery , cohort , viral load , anemia , gestation , retrospective cohort study , gynecology , pediatrics , human immunodeficiency virus (hiv) , immunology , genetics , biology
Background To describe the findings of a German HIV‐pregnancy cohort. To investigate factors associated with pregnancy complications and outcomes in HIV‐infected women. Methods Retrospective analysis of HIV pregnancies from 2008 to 2010 in six German outpatient clinics specialized in HIV care. Results 230 mother‐child pairs were included in the evaluation. In 25 cases, HIV infection was diagnosed during pregnancy (mean gestational age 17.5 weeks) with a mean CD4 cell count of 364 cells/µl and a median viral load (VL) of 6,660 copies/ml. 150 (65.2%) women were antiretroviral therapy (ART)‐experienced prior to pregnancy; 112 (48.7%) received ART at conception; a further 97 (42.2%) started ART during pregnancy at an average gestational age of 25 weeks. Anemia was documented in 36.5% of the women with an average hemoglobin of 9.5 g/dl. Mean gestational age at delivery was 38±2.41 weeks; range 24–42 weeks. 17 births (7.4%) were preterm. Average CD4 cell count at time of delivery was 447 cells/µl; in 162 (70.4%) cases, VL was <50 copies/ml. Mode of delivery was as follows: 70 (30.4%) vaginal, 131 (57%) primary and 29 (12.6%) secondary Caesarian (C)‐section. Vaginal delivery was associated with a higher gestational age at delivery (39.1 vs 37.5 weeks, p<0.001). Maternal CDC disease stage was found to be correlated with premature contractions (p=0.025), shortened cervix (p=0.044) and gestational age at delivery (p=0.042). Further, healthier women, according to CDC classification, were more likely to deliver vaginally (p<0.001). No vertical HIV transmission was documented. Mean birth weight was 2922±580 g. Conclusions In this cohort, lower CD4 counts were associated with preterm contractions, shortened cervix, and a lower gestational age at delivery. In addition, women with less advanced disease were more likely to deliver vaginally.