Incidence and Determinants of Adverse Neonatal Outcomes among HIV-Positive Pregnant Women: A Prospective Cohort Study at Regional Referral Hospitals in Uganda

Abstract

HIV infection remains a significant global health challenge, affecting over 37.9 million people worldwide. Despite widespread access to antiretroviral therapy (ART), adverse neonatal outcomes are prevalent among pregnant women living with HIV. This prospective cohort study aimed to determine the incidence and factors associated with early adverse neonatal outcomes among HIV-positive mothers at Mubende and Fort Portal Regional Referral Hospitals (MRRH and FRRH), compared to HIV-negative mothers. The study excluded mothers with known risks for adverse neonatal outcomes. Neonates were monitored from birth to discharge within 7 days for adverse outcomes. Among 203 participants, 135 were HIV-negative and 68 were HIV-positive. Adverse neonatal outcomes were more frequent in the HIV-positive group (39.7% vs. 28.1%), although the difference was not statistically significant (P=0.096). Prematurity (20.6% vs. 8.1%, P=0.031) and low birth weight (25.0% vs. 12.6%, P=0.047) were significantly higher among HIV-positive mothers. Multivariate analysis identified detectable viral load as a significant risk factor for early neonatal adverse outcomes (aRR=4.036, CI=1.428-11.406, P=0.008). These findings underscore the importance of close monitoring and viral load suppression in HIV-positive mothers. Further research is needed to understand the causes of detectable viral loads in mothers on ART and to capture neonatal adverse outcomes beyond 7 days post-delivery. Keywords: HIV, Adverse neonatal outcomes, Antiretroviral therapy (ART), Viral load, Prematurity, Low birth weight, public health and Maternal health