Abstract
Fetal and placental growth disorders are common in maternal human immunodeficiency virus (HIV) infection and can be attributed to both the infection and comorbidities not associated with HIV. We describe placental growth disorders and adverse reproductive outcomes in HIV-infected pregnant women whose delivery occurred between 2001–2014 in Vitoria, Brazil. Cases with gestational age (GA) ≥ than 22 weeks validated by ultrasonography, with placental and fetal weight dimensions at birth, were studied. Outcomes were summarized as proportions of small (SGA), appropriate (AGA), and large (LGA) for GA when the z-score values were below -1.28, between -1.28 and +1.28, or above +1.28, respectively. Of 187 fetal attachment requisitions, 122(65.2%) women and their newborns participated in the study. The median maternal age was 28 years and 81(66.4%) underwent ≥ 6 prenatal visits. A total of 81(66.4%) were diagnosed before current pregnancy; 68(55.7%) exhibited criteria for acquired immunodeficiency syndrome (AIDS); 64(52.4%) had detectable viral load; 25(20.5%) cases presented SGA placental weight and 6(4.9%) SGA placental thickness. SGA placental area was observed in 41(33.6%) cases, and among the SGA placental weight cases 12(48%) were also SGA fetal weight. Preterm birth (PTB) occurred in 15.6%(19/122) of cases; perinatal death in 4.1%(5/122) and HIV vertical transmission in 6 of 122 (4.9%). Women, ≥36 years old, were 5.7 times more likely to have PTB than those under 36. Also, patients with AIDS-defining criteria were 3.7 times more likely to have PTB. Prenatal care was inversely associated with PTB. Statistically significant associations were observed between AGA placental area and Protease Inhibitor usage and between SGA placental weight and SGA area. We found a prevalence of placental growth disorders in HIV-infected pregnant women and values higher than international reference values. The restriction of placental growth was a common disorder, possibly attributed to virus effects or a combination of antiretroviral regimens.
Highlights
The placenta is the organ of fetal adaptation to the maternal environment that is responsible for mechanical protection, nutrition, hormone production, gas exchange, hydro electrolytic control, and elimination of fetal excreta [1]
We identified 187 requests for fetal annexes examination at the university hospital during the study period. 65 cases (35%) were excluded because of technical problems with the specimens, Placental growth disorders and perinatal adverse outcomes in human immunodeficiency virus (HIV)-infected pregnant women and the final sample consisted of 122 cases (65.2%)
small for gestational age (SGA) thickness occurred in 4.9% of cases (6/ 122), a lower occurrence than the reference value of 10% corresponding to a direct increase (DI) of -5.1%
Summary
The placenta is the organ of fetal adaptation to the maternal environment that is responsible for mechanical protection, nutrition, hormone production, gas exchange, hydro electrolytic control, and elimination of fetal excreta [1]. Placental weight is a strong predictor of infant weight at birth and is commonly used as a summary of total organ growth, presumably reflecting maternal support, efficiency, and the functional adaptive capacity of the placenta [4]. In addition to placental weight, an assessment of placental area and thickness can be made during the second-trimester ultrasound examination, considering that a small placenta would be an indication of poor gestational prognosis and a predictor of preeclampsia [7] or perinatal morbidity. Previous studies have shown that placental volume estimated by ultrasonographic evaluation in the second trimester can predict both placental and birth weight [8]
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