Pregnancy outcome in women with β-thalassemia major and HIV infection

Abstract

Objectives. To conduct a study of maternal and foetal outcome in pregnant transfusion-dependent β-thalassemia major (β-TM) women with HIV-1 disease. Study design. The course and outcome of pregnancy was studied prospectively in 123 women with transfusion-dependent β-thalassemia major, of which 81 were HIV-1 positive, at Sanjay Gandhi hospital Manipur, India, from January 1990 to January 1997. The clinical and immunological status of the seropositive women was compared with matched seronegative thalassemic control groups. Results. Over a period of 7 years, 123 women with β-TM conceived. One hundred and eleven (90%) conceptions were spontaneous including the 81 HIV-1 positive women and 12 (10%) conceptions occurred after induction of ovulation. Among these 81 patients the following stages of HIV-1 infection were represented: 39 C2 stage (AIDS indicator conditions); 42 A2 stage (asymptomatic) (CDC 1993). Of these 39 women, 12/39 (31%) underwent medical termination of pregnancy (MTP) by 8 weeks gestation and five (13%) died undelivered by 32 weeks gestation due to fulminating pneumocystis carinii pneumonia. There were 80/123 (65%) singleton vaginal deliveries of which 22/80 (28%) were preterm and 58 (71%) term. All 22 preterm births occurred in mothers with aids indicator conditions, were vaginal deliveries, and they had positive viral cultures for HIV-1 within one week of birth. Ten of these neonates died by 8 weeks of AIDS and the remaining 12 died of AIDS indicator disease by 15 months of age. At term a significant 25% (31/123) of women delivered by elective caesarean section due to cephalopelvic disproportion. Except for those inflicted with AIDS, the remaining women remained well throughout pregnancy. Conclusion. Successful outcome of pregnancies does occur in women with β-TM and also in those with asymptomatic HIV disease. Associated AIDS indicator conditions cause appreciable perinatal and maternal morbidity and mortality.