Abstract
BackgroundHigh blood pressure (BP) late in pregnancy is associated with preterm delivery (PTD); BP has also been associated with HIV and antiretroviral therapy (ART), but whether the relationship between BP assessed longitudinally over pregnancy and PTD and low birthweight (LBW) is modified by HIV/ART is unclear. We hypothesise the presence of distinctive BP trajectories and their association with adverse birth outcomes may be mediated by HIV/ART status.MethodsWe recruited pregnant women at a large primary care facility in Cape Town. BP was measured throughout pregnancy using automated monitors. Group-based trajectory modelling in women with ≥3 BP measurements identified distinct joint systolic and diastolic BP trajectory groups. Multinomial regression assessed BP trajectory group associations with HIV/ART status, and Poisson regression with robust error variance was used to assess risk of PTD and LBW.ResultsOf the 1583 women in this analysis, 37% were HIV-infected. Seven joint trajectory group combinations were identified, which were categorised as normal (50%), low normal (25%), high normal (20%), and abnormal (5%). A higher proportion of women in the low normal group were HIV-infected than HIV-uninfected (28% vs. 23%), however differences were not statistically significant (RR 1.27, 95% CI 0.98–1.63, reference category: normal). In multivariable analyses, low normal trajectory (aRR0.59, 0.41–0.85) was associated with decreased risk of PTD, while high normal (aRR1.48, 1.12–1.95) and abnormal trajectories (aRR3.18, 2.32–4.37) were associated with increased risk of PTD, and abnormal with increased risk of LBW (RR2.81, 1.90–4.15).ConclusionsWhile HIV/ART did not appear to mediate the BP trajectories and adverse birth outcomes association, they did provide more detailed insights into the relationship between BP, PTD and LBW for HIV-infected and uninfected women.
Highlights
High blood pressure (BP) late in pregnancy is associated with preterm delivery (PTD); BP has been associated with HIV and antiretroviral therapy (ART), but whether the relationship between BP assessed longitudinally over pregnancy and PTD and low birthweight (LBW) is modified by HIV/ART is unclear
Gestational age (GA) was routinely established at the first Antenatal Care (ANC) visit based on last menstrual period (LMP) and symphysis-fundal height (SFH), with any woman clinically assessed (LMP and/or SFH) to be ≤24 weeks gestation referred for a same day ultrasound by the PIMS research sonographer using standardized assessment protocols and blinded to the midwife GA assessment
Differences were observed by ART status with a higher proportion of women initiating ART in pregnancy classified as hypertensive compared to those initiating preconception (7% vs 4%)
Summary
High blood pressure (BP) late in pregnancy is associated with preterm delivery (PTD); BP has been associated with HIV and antiretroviral therapy (ART), but whether the relationship between BP assessed longitudinally over pregnancy and PTD and low birthweight (LBW) is modified by HIV/ART is unclear. Differential HDP risk has been theorised to exist in immunocompromised states, such as HIV-infection in pregnancy especially with antiretroviral therapy (ART) use. This was demonstrated in a recent systematic review showing increased HDP risk in HIV-infected women on ART, those using protease inhibitors (PI) based regimens, compared to untreated HIV-infected women [6]. BP trajectories may provide more accurate insights into the relationship between BP and maternal, perinatal and neonatal outcomes than cross-sectional assessments and could inform development of interventions for improvement in HDP management
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