Trends in Management and Outcome of Pregnancies in HIV-Infected Women in the UK and Ireland, 1990–2006

Abstract

Changes in the demographic profile of diagnosed HIV-infected pregnant women and trends in pregnancy outcome, interventions, and mother-to-child transmission are followed over time in the United Kingdom and Ireland through active surveillance of obstetric and pediatric HIV in the National Study of HIV in Pregnancy and Childhood. The authors used this database to examine data from a total of 8327 pregnancies between the years 1990 and 2006 in diagnosed HIV-infected pregnant women. The main outcome measures evaluated were maternal characteristics, pregnancy outcome, use of antiretroviral therapy, mode of delivery, and mother-to-child transmission. Reported pregnancies increased from 82 in 1990 to 1394 in 2006. The proportion of pregnant women who probably acquired HIV through injecting drug use declined greatly from 49.2% (185/376) in 1990–1993 to 3.1% (125/4009) in 2004–2006 (P < .001). From 1990–1993 to 2004–2006, the proportion of the women born in sub-Saharan Africa increased by 35% (43.5% to 78.6% [P < .004]). During these same time periods, there was a marked reduction in reported pregnancy terminations: from 30% (111/376) to 3.4% (135/4009) (P < .001). Between 1995 and 2006, most deliveries (56.4%) were by elective caesarean section; rates were highest in 1999. Vaginal deliveries increased from 16.6% (36/217) in 1999 to 28.3% (321/1136) in 2006 (P < .001). With increased use of antiretroviral therapy in pregnancy over time, reaching 98.4% (1092/1110) in 2006, the overall mother-to-child transmission rate declined from 18.5% (35/189) in 1990–1993 to 1.0% (29/2832) in 2004–2006. The authors conclude from these findings that substantial changes in pregnancy management and outcome between 1999 and 2006 reflect the marked improvements in identification of HIV-infected women as well as interventions that markedly reduce the risk of mother-to-child transmission.