Background:
HIV-infected women, particularly those with advanced disease, may have higher rates ofpregnancy loss (miscarriage and stillbirth) and neonatal mortality than uninfected women.Here we examine risk factors for these adverse pregnancy outcomes in a cohort of HIVinfectedwomen in Zambia considering the impact of infant HIV status.
Methods:
A total of 1229 HIV-infected pregnant women were enrolled (2001-2004) in Lusaka, Zambiaand followed to pregnancy outcome. Live-born infants were tested for HIV by PCR at birth, 1week and 5 weeks. Obstetric and neonatal data were collected after delivery and the rates ofneonatal (<28 days) and early mortality (<70 days) were described using Kaplan-Meier
Methods:
ResultsThe ratio of miscarriage and stillbirth per 100 live-births were 3.1 and 2.6, respectively.Higher maternal plasma viral load (adjusted odds ratio [AOR] for each log10 increase in HIVRNA copies/ml = 1.90; 95% confidence interval [CI] 1.10-3.27) and being symptomatic wereassociated with an increased risk of stillbirth (AOR = 3.19; 95% CI 1.46-6.97), anddecreasing maternal CD4 count by 100 cells/mm3 with an increased risk of miscarriage(OR = 1.25; 95% CI 1.02-1.54). The neonatal mortality rate was 4.3 per 100 increasing to 6.3by 70 days. Intrauterine HIV infection was not associated with neonatal morality but becameassociated with mortality through 70 days (adjusted hazard ratio = 2.76; 95% CI 1.25-6.08).Low birth weight and cessation of breastfeeding were significant risk factors for bothneonatal and early mortality independent of infant HIV infection.
Conclusions:
More advanced maternal HIV disease was associated with adverse pregnancy outcomes.Excess neonatal mortality in HIV-infected women was not primarily explained by infant HIVinfection but was strongly associated with low birth weight and prematurity. Intrauterine HIVinfection contributed to mortality as early as 70 days of infant age. Interventions to improvepregnancy outcomes for HIV-infected women are needed to complement necessarytherapeutic and prophylactic antiretroviral interventions.