Obstetric and perinatal outcome in human immunodeficiency virus-infected pregnant women with and without opiate addiction.

Abstract

This study was undertaken to assess the impact on gestation played by the simple human immunodeficiency virus (HIV)-seropositive status either alone or complicated by opiate abuse in the absence of other confounding variables. To this purpose the main obstetric complications and the perinatal outcome were prospectively evaluated in 38 simple HIV-infected women, 14 of whom were simple carriers and 24 under methadone treatment, and in 76 uninfected women, 16 of whom were methadone users and 60 controls. In simple HIV-carriers maternal weight gain (P < 0.001) and both 1- and 5-min Apgar scores (P < 0.005) were reduced whereas the incidence of miscarriage was increased (P < 0.05). Worse obstetric and perinatal outcomes were found in HIV-seropositive drug addicts, in which gestational length (P < 0.001), maternal weight gain (P < 0.001) and Apgar scores were lower (P < 0.005 and P < 0.001, respectively) and the rate of preterm labour, small for gestational age newborns, vaginal and urinary infections as well as of unexplained fever (P < 0.05) was higher. Outcomes were similar in HIV-seropositive and seronegative drug addicts and in both groups a positive correlation (r = 0.62 P < 0.001, and r = 0.44, respectively) was found between the number of infectious episodes throughout pregnancy and the mean dose of opiate consumed daily. Our results suggest that HIV-seropositive condition might exert slight direct and indirect detrimental effects on pregnancy. Whatever the maternal serologic status, opiate intake not only causes a further worsening of gestational and perinatal outcomes, but also increases the susceptibility towards pathogens.