Correlates and outcomes of preterm birth, low birth weight, and small for gestational age in HIV-exposed uninfected infants

BMC Pregnancy and Childbirth

Grace John-Stewart⁵  Carey Farquhar⁵  Dorothy Mbori-Ngacha⁴  Rose Bosire⁴  Elizabeth Maleche-Obimbo⁴  Barbra A Richardson²  Gwen Ambler¹  Janna Patterson³  Jennifer A Slyker⁶ 

[1] Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, USA;Department of Biostatistics, University of Washington, Seattle, USA;Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, USA;Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya;Department of Epidemiology, University of Washington, Seattle, USA;Department of Global Health, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA 98104, USA

关键词: Pediatric HIV;    Small for gestational age;    Low birth weight;    Preterm birth;   

Others  :  1131834
DOI  :  10.1186/1471-2393-14-7

 received in 2013-08-02, accepted in 2014-01-03,  发布年份 2014

【 摘 要 】

Background

Preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA) contribute to neonatal mortality. Maternal HIV-1 infection has been associated with an increased risk of PTB, but mechanisms underlying this association are undefined. We describe correlates and outcomes of PTB, LBW, and SGA in HIV-exposed uninfected infants.

Methods

This was a retrospective analysis of cohort study. Between 1999–2002, pregnant, HIV-infected women were enrolled into an HIV-1 transmission study. Logistic regression was used to identify correlates of PTB, LBW and SGA in HIV-negative, spontaneous singleton deliveries. Associations between birth outcomes and mortality were measured using survival analyses.

Results

In multivariable models, maternal plasma (OR = 2.1, 95% CI = 1.1-3.8) and cervical HIV-1 RNA levels (OR = 1.6, 95% CI = 1.1-2.4), and CD4 < 15% (OR = 2.4, 95% CI = 1.0-5.6) were associated with increased odds of PTB. Abnormal vaginal discharge and cervical polymorphonuclear leukocytes were also associated with PTB. Cervical HIV-1 RNA level (OR = 2.4, 95% CI = 1.5-6.7) was associated with an increased odds of LBW, while increasing parity (OR = 0.46, 95% CI = 0.24-0.88) was associated with reduced odds. Higher maternal body mass index (OR = 0.75, 95% CI = 0.61-0.92) was associated with a reduced odds of SGA, while bacterial vaginosis was associated with >3-fold increased odds (OR = 3.2, 95% CI = 1.4-7.4). PTB, LBW, and SGA were each associated with a >6-fold increased risk of neonatal death, and a >2-fold increased rate of infant mortality within the first year.

Conclusions

Maternal plasma and cervical HIV-1 RNA load, and genital infections may be important risk factors for PTB in HIV-exposed uninfected infants. PTB, LBW, and SGA are associated with increased neonatal and infant mortality in HIV-exposed uninfected infants.

【 授权许可】

   
2014 Slyker et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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