Changing trends in pregnancy outcome among HIV-infected women between 1985 and 1997 in two southern French university hospitals

Abstract

Objectives: To analyze risk factors for pregnancy outcome among HIV-infected women before and after introduction of AZT prophylaxis in 1994. Study design: A prospective, two-center observational study conducted from 1 January 1985 to 31 December 1997. Patients: Pregnant HIV-infected women followed in one of the obstetrics units during the study period. Main outcome measures: pregnancy outcome (normal delivery, ectopic pregnancy, spontaneous abortion, voluntary termination of pregnancy (TOP) according to year of pregnancy, age at pregnancy professional status, marital status, ethnic origin, mode of contamination, stage of disease, partner’s human immunodeficiency virus (HIV) status and prior pregnancy. Results: One thousand one hundred and three pregnancies among 937 HIV-infected women were studied. Mean age of patients was 28.1±4.9 years. Pregnancy outcomes were distributed as follows: 473 normal deliveries, 589 TOP, 9 ectopic pregnancies and 32 spontaneous abortions. The proportion of TOP decreased from 59.4% before 1994 to 37.5% from 1994 ( P<0.001). In univariate analysis, mode of transmission, marital status, ethnic origin, partner’s HIV status and prior pregnancy were also significantly correlated with pregnancy outcome. However, after adjustment by logistic regression for each period (before and after 1994), mode of transmission no longer appeared to influence pregnancy outcome. Conclusion: Effective prevention of mother-to-child transmission of HIV infection appears to have influenced HIV-infected women’s decisions on continuing their pregnancy to term. Incidence of voluntary TOP has decreased significantly after introduction of AZT.