84 Prematurity in Infants Born to Hiv-Seropositive Mothers

Abstract

Background: Premature birth occurs in approximately 10% of normal infants. There are limited data regarding the risk of premature delivery and other adverse outcomes of pregnancy in HIV-seropositive women receiving antiretroviral therapy.This study assessed the rate of prematurity in infants born to HIV-seropositive mothers and evaluated whether any relationship may exist between maternal HIV RNA copy number and prematurity. Methods: Maternal viral load, vertical transmission rate and neonatal outcome were prospectively evaluated in a consecutive (1/1/2001–31/12/2003) series of 156 mother-infant pairs followed at the same Institution up to eighteen months from delivery. Gestational age was based on the last menstruation date and confirmed by an ultrasound examination performed within the 20th week. Maternal viral load was determined during the last trimester of pregnancy, using branched DNA and/or NASBA technique. Deliveries at less than 37 weeks were defined as premature. The diagnosis of HIV-infection in infants was based on a positive PCR for HIV in blood obtained at one and three months of life. Variables assessed included ethnicity, drug use antiretroviral therapy during pregnancy and mode of delivery. Results: Out of 156 women, 86% were White, 9% Black, and 5% Hispanic. Eighteen (11.5%) women actively used drugs. Combined therapy during pregnancy was administered in 95% of mothers; six mothers refused any therapy. Most women (98%) underwent caesarean section. Maternal viral load (copy/ml) was: < 1000, 70%; > = 1000, 30%; median (range), 217 (0–370000). Birth weight (g) was: < 1000, 3.8%; 1001–1499, 2.0%; 1500–2499, 21.1%; > = 2500, 73.1%. Premature birth occurred in 29% of infants (95% confidence interval [CI], 26–32%). Only one infant, born at term, whose mother did not receive antiretroviral therapy during pregnancy, was vertically HIV-infected. No significant difference in rate of premature birth was found between infants born to mother having or not viral load > = 1000 copy/ml (75% vs. 68%, odds ratio [95%CI], 1.4 [0.6–3.4]). Conclusion: Within the population studied, the rate of premature birth was markedly high as compared to normal infants. No evident association was found between maternal HIV RNA copy number and prematurity. Supported by AISTMAR