Pregnancy Outcomes in HIV-Infected Women: Experience from a Tertiary Care Center in India

Vatsla Dadhwal, Md,Plaboni Sarkar, Md,Aparna Sharma, Md,Kavita Khoiwal, Md,P Vanamail, Mps, Phd,Dipika Deka, Md

doi:10.21106/ijma.196

Abstract

Background and Objectives:There is conflicting data on the effect of HIV infection as well as antiretroviral therapy (ART) on pregnancy outcome. The objectives of this study were to compare pregnancy outcomes in women with and without HIV infection, and to evaluate the effect of HAART on pregnancy in HIV-infected women.Methods:This is a prospective case record analysis of 212 HIV-infected women delivering between 2002 and 2015, in a tertiary health care center in India. The pregnancy outcome in HIV-infected women was compared to 238 HIV-uninfected controls. Women received ART for prevention of mother to child transmission as per protocol which varied during the period of study. Effect of use of ART on preterm birth (PTB) and intrauterine growth restriction (IUGR) was analyzed.Results:HIV-infected women were more likely to have PTB, IUGR, and anemia (9.4%, 9.9%, 5.2%) compared to uninfected women (7.6%, 5%, 3.8%), this did not reach statistical significance (P-value = >0.05). The incidence of PIH, diabetes mellitus and intrahepatic cholestasis of pregnancy was similar in both groups. Mean birth weight was significantly lower in neonates of HIV-infected women (2593.60±499g) than HIV-uninfected women (2919±459g) [P-value=0.001]. neonatal intensive care unit admissions were also significantly higher in infants born to HIV-infected women (P-value=0.002). HIV-infected women on ART had decreased incidence of PTB and IUGR.Conclusion and Global Health Implications:Good antenatal care and multidisciplinary team approach can optimize pregnancy outcomes in HIV-infected women.

Highlights

Perinatal transmission of human immunodeficiency virus (HIV) infection occurs in the absence of any interventions.The benefits of antiretroviral treatment (ART) in decreasing mother to child transmission (MTCT) of HIV infection are largely undisputed.[1]
Current practice has adopted the use of highly active antiretroviral therapy (HAART) in an attempt to suppress viral load below detection, to minimize MTCT of HIV
In India, the program for Prevention of Mother to Child Transmission (PMTCT) of HIV was launched in the year 2002

Summary

Introduction

Perinatal transmission of human immunodeficiency virus (HIV) infection occurs in the absence of any interventions.The benefits of antiretroviral treatment (ART) in decreasing mother to child transmission (MTCT) of HIV infection are largely undisputed.[1]. With effect from 2014, India adopted the World Health Organization (WHO) instigated Option B+ for prevention of MTCT of HIV.[1]There are two concerns in HIVinfected women becoming pregnant: The effect of HIV infection on pregnancy and the effect of HAART on pregnancy outcome. The published literature shows conflicting results on this.[2,3,4,5,6] The objective of this study was to compare pregnancy outcome in women with and without HIV infection. There is conflicting data on the effect of HIV infection as well as antiretroviral therapy (ART) on pregnancy outcome.The objectives of this study were to compare pregnancy outcomes in women with and without HIV infection, and to evaluate the effect of HAART on pregnancy in HIV-infected women

Objectives

Results

Discussion

Conclusion