Factors associated with delivering premature and/or low birth weight infants among pregnant HIV-positive women on antiretroviral treatment at Dr George Mukhari Hospital, South Africa

N N Gibango,T S Ntuli,S Mda

doi:10.4102/sajid.v33i2.18

Abstract

Background: Prematurity and low birthweight (LBW) deliveries amongst pregnant women infected with the human immunodeficiency virus (HIV) remain a challenge worldwide. The association between prematurity, LBW and antiretroviral therapy (ART) or prophylactic antiretroviral drug (ARV) exposure in pregnancy is unclear. This study evaluates the risk of delivering a premature and/or LBW infant among HIV-positive pregnant women on ART or prophylactic ARV.Methods: A cross-sectional study was conducted (April to October 2012). HIV-positive women on prophylactic ARV (dual therapy) or lifelong ART (triple therapy or HAART) were enrolled in the study. Women who did not have a documented HIV result during pregnancy, those tested before delivery and those found to be HIV-positive were considered as not exposed to ARV drugs during pregnancy. This group received a standard dose of nevirapine during labour. The control group was made up of HIV-negative women.Results: Of the 496 mothers enrolled in the study, 59% (288/496) were HIV-positive, of whom 72% (206/288) were on ART or prophylactic ARV. The mean age was 27.6 ± 6.5 years (15 to 47 years). The mean gestational age (GA) was 35.9 ± 3.6 weeks (24– 42 weeks). Infants’ birthweights ranged from 550 to 4 900 g (2.5 ± 0.9 kg). HIV-positive mothers not on ART or ARV prophylaxis were likely to deliver an infant at GA 28 weeks (p 0.05) or birthweight 1 000 g (p 0.05) compared with their counterparts. Conclusion: HIV-positive pregnant women not on ART or ARV prophylaxis were at a risk of delivering babies at GA 28 weeks or birthweight 1 000 g. There is a need to encourage early and regular attendance for antenatal care so that HIV-positive pregnant women can be identified and have access to treatment during pregnancy.

Highlights

An estimated 36.7 million people were living with the human immunodeficiency virus (HIV) worldwide in 2015, of which most (68%) lived in sub-Saharan Africa.[1]
In South Africa (SA), the national surveillance of HIV and syphilis infection found an HIV prevalence of 29.7% amongst pregnant women in 2013.2 The use of antiretroviral therapy (ART) and antiretroviral (ARV) prophylaxis for the reduction of mother-to-child transmission of HIV has been a global health strategy since 2000; studies have provided inconsistent findings regarding the association between premature births, low birthweight (LBW) and ARV drug exposure
There is clear evidence of the benefits of ARV drug regimens given to pregnant women for both the mother and infant;[3,4,5,6] studies in developed countries have found an increased rate of advanced maternal age, LBW and premature birth in HIVpositive women on ART when compared with HIV-negative women.[7,8]

Summary

Introduction

An estimated 36.7 million people were living with the human immunodeficiency virus (HIV) worldwide in 2015, of which most (68%) lived in sub-Saharan Africa.[1]. This study evaluates the risk of delivering a premature and/or LBW infant among HIV-positive pregnant women on ART or prophylactic ARV. Women who did not have a documented HIV result during pregnancy, those tested before delivery and those found to be HIV-positive were considered as not exposed to ARV drugs during pregnancy. This group received a standard dose of nevirapine during labour. Conclusion: HIV-positive pregnant women not on ART or ARV prophylaxis were at a risk of delivering babies at GA < 28 weeks or birthweight < 1 000 g. There is a need to encourage early and regular attendance for antenatal care so that HIV-positive pregnant women can be identified and have access to treatment during pregnancy

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