Perinatal HIV transmission and pregnancy outcomes in indigenous women in Western Australia

Abstract

Implementation of obstetric and neonatal interventions has reduced mother to child transmission of HIV. Health outcomes for Aboriginal people are often worse than for non-Aboriginal people; was this the case for HIV infection in pregnancy? To compare the management and outcomes of pregnancy in Aboriginal and non-Aboriginal HIV-positive women in Western Australia (WA). A retrospective study of all pregnancies delivered in WA to HIV-infected women from 1991 until 2005. Managed pregnancies were compared in Aboriginal and non-Aboriginal women. Outcome measures were HIV status of the babies, birthweight, rates of caesarean delivery and perinatal mortality. Fifty-six pregnancies occurred in 41 HIV-infected women resulting in 54 live births. Of the 41 women, 16 (39%) were Aboriginal. In regard to birthweight, perinatal mortality, rates of caesarean section and rates of HIV perinatal transmission, there was no significant difference between babies born to Aboriginal and those born to non-Aboriginal mothers. In contrast, of the eight pregnancies, with no contact with the multidisciplinary team, five babies (63%) were infected with HIV (2% vs 63%P = 0.001). There was no case of perinatal HIV infection in 22 pregnancies of the Aboriginal women that received care through the multidisciplinary team; perinatally acquired HIV occurred in the first pregnancy of one of these women before she was aware of her status when she was not managed by the team. Similar outcomes can be achieved in both HIV-positive Aboriginal and non-Aboriginal women, through intensive, culturally appropriate, multidisciplinary care and without elective caesarean delivery.