Incidence of and socio-biologic risk factors for spontaneous preterm birth in HIV positive Nigerian women

BMC Pregnancy and Childbirth

Innocent AO Ujah¹  Dan I Onwujekwe¹  Ebiere C Herbertson¹  Esther O Somefun¹  Olutosin Odubela¹  Oluwafunke Ilesanmi¹  Sabdat O Ekama¹  Zaidat A Musa¹  Bamidele Oke¹  Rosemary A Adu¹  Titilola A Gbajabiamila¹  Paschal M Ezeobi¹  Olufunto O Kalejaiye¹  David A Oladele¹  Harry Ohwodo¹  Chidinma V Gab-Okafor¹  Agatha N David¹  Oliver C Ezechi¹ 

[1] HIV Treatment Centre, Clinical Sciences Division, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria

关键词: Low birth weight;    CD4 count;    Viral load;    Pregnancy;    Spontaneous preterm birth/delivery HIV;   

Others  :  1152437
DOI  :  10.1186/1471-2393-12-93

 received in 2011-07-30, accepted in 2012-08-31,  发布年份 2012

【 摘 要 】

Background

Recent studies have identified HIV as a leading contributor to preterm delivery and its associated morbidity and mortality. However little or no information exists in our sub-region on this subject. Identifying the factors associated with preterm delivery in HIV positive women in our country and sub-region will not only prevent mother to child transmission of HIV virus but will also reduce the morbidity and mortality associated with prematurity and low birth weight. This study was designed to determine the incidence and risk factors for preterm delivery in HIV positive Nigerians.

Method

The required data for this retrospective study was extracted from the data base of a cohort study of the outcome of prevention of mother to child transmission at the Nigerian Institute of Medical Research, Lagos. Only data of women that met the eligibility of spontaneous delivery after 20 weeks of gestation were included. Ethical approval was obtained from the Institution’s Ethical Review Board.

Results

181 women out of the 1626 eligible for inclusion into the study had spontaneous preterm delivery (11.1%). The mean birth weight was 3.1 ± 0.4 kg, with 10.3% having LBW. Spontaneous preterm delivery was found to be significantly associated with unmarried status (cOR: 1.7;1.52-2.57), baseline CD4 count <200 cells/mm³(cOR: 1.8; 1.16-2.99), presence of opportunistic infection at delivery (cOR: 2.2;1.23-3.57), multiple pregnancy (cOR 10.4; 4.24 – 26.17), use of PI based triple ARV therapy (eOR 10.2; 5.52 – 18.8) in the first trimester (cOR 2.5; 1.77 – 3.52) on univariate analysis. However after multivariate analysis controlling for potential confounding variables including low birth weight, only multiple pregnancy (aOR: 8.6; CI: 6.73 – 12.9), presence of opportunistic infection at delivery (aOR: 1.9; CI: 1.1 – 5.7), and 1st trimester exposure to PI based triple therapy (aOR: 5.4; CI: 3.4 – 7.8) retained their significant association with preterm delivery.

Conclusion

The spontaneous preterm delivery rate among our cohort was 11.1%. HIV positive women with multiple pregnancies, symptomatic HIV infection at delivery and first trimester fetal exposure to PI based triple therapy were found to be at risk of spontaneous preterm delivery. Early booking and non-use of PI based triple therapy in the first trimester will significantly reduce the risk of preterm delivery.

【 授权许可】

   
2012 Ezechi et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Simmons LE, Rubens CE, Darmstadt GL, Gravett MG: Preventing Preterm Birth and Neonatal Mortality: Exploring the Epidemiology, Causes, and Interventions. Semin Perinatol 2010, 34(6):408-415.
• [2]Lawn JE, Cousens S, Zupan J: 4 million neonatal deaths: When? Where? Why? Lancet 2005, 365:891-900.
• [3]Rajaratnam JK, Marcus JR, Flaxman AD, Wang H, Levin-Recto A, Dwyer L, Costa M, Lopez AD, Murray CJL: Neonatal, post neonatal, childhood, and under-5 mortality for 187 countries, 1970–2010: a systematic analysis of progress towards Millennium Development Goal 4. Lancet 2010, 375:1988-2008.
• [4]Cousens S, Stanton C, Blencowe H, et al.: National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet 2011.
• [5]Feresu SA, Harlow SD, Welch K, Gillespie BW: Incidence of stillbirth and perinatal mortality and their associated factors among women delivering at Harare Maternity Hospital, Zimbabwe: a cross-sectional retrospective analysis. BMC Pregnancy Childbirth 2005, 5:9. BioMed Central Full Text
• [6]Etuk SJ, Etuk IS, Oyo-Ita AE: Factors influencing the incidence of pre-term birth in Calabar, Nigeria. Nigerian Journal Of Physiological Sciences 2005, 20(1–2):63-68.
• [7]Chike-Obi U: Preterm delivery in Ilorin: multiple and teenage pregnancies as major aetiological factors. West Afr J Med 1993, 12(4):228-230.
• [8]Mokuolu AO, Abdul IF, Adesiyun O: Maternal factors associated with early spontaneous singleton preterm delivery in Nigeria. Trop J Obstet Gynaecol 2002, 19:32-35.
• [9]NACA: Update on the HIV/AIDS epidemic and response in Nigeria. National Agency for Control of AIDS. Abuja Nigeria; 2011. http://naca.gov.ng/content/view/423/lang,en/ webcite
• [10]WHO: Towards the elimination of mother-to –child transmiss ion of HIV. Report of a WHO technical consultation. WHO, Geneva; 2011. http://www.who.int/hiv/pub/mtct/elimination_report/en/index.html webcite
• [11]Afe AJ, Adewum N, Emokpa A, Fagorala T, Disu AE, Ganikale I, Audu R: Outcome of PMTCT services and factors affecting vertical transmission of HIV infection in Lagos, Nigeria. HIV & AIDS Review 2011, 10(1):14-18.
• [12]Ezechi OC, Makinde ON, Kalu BEK, Nnatu SNN: Risk factors for preterm delivery in South Western Nigeria. J Obstet Gynaecol 2003, 23(4):387-391.
• [13]Taguebue J, Monebenimp F, Zingg W, Mve Koh V, Atchoumi A, Gervaix A, Tetanye E: Risk Factors for Prematurity among Neonates from HIV Positive Mothers in Cameroon. World Journal of AIDS 2011, 1:1-7.
• [14]Bulterys M, Chao A, Munyemana S, Kurawige JB, Naw-rocki P, Habimana P, et al.: Maternal human immunodeficiency virus 1 infection and intrauterine growth: a pro- spective cohort study in Butare, Rwanda. Pediatr Infect Dis J 1994, 13(2):94-100.
• [15]Brocklehurst P, French R: The association between maternal HIV infection and perinatal outcome: a systematic review of the literature and meta-analysis. Br J Obstet Gynaecol 1994, 105(8):836-848.
• [16]Olusanya O, Okpere E, Ezimokhai M: The importance of social class in voluntary fertility control in a developing country. West Afr J Med 1985, 4:205-211.
• [17]Dreyfuss ML, Msamanga GI, Spiegelman D, Hunter DJ, Urassa EJ, Hertzmark E, et al.: Determinants of low birth weight among HIV-infected pregnant women in Tanzania. Am J Clin Nutr 2001, 74(6)):814-826.
• [18]Castetbon K, Ladner J, Leroy V, Chauliac M, Karita E, De Clercq A, et al.: Low birth weight in infants born to African HIV-infected women: relationship with maternal body weight during pregnancy: Pregnancy and HIV Study Group (EGE). J Trop Pediatr 1999, 45(3):152-157.
• [19]Townsend CL, Cortina-Boria M, Peckham CS, Tookey PA: Antiretroviral therapy and premature delivery in diagnosed HIV-infected women in the United Kingdom and Ireland. AIDS 2007, 21:1019-1026.
• [20]European Collaborative Study: Swiss Mother and Child Cohort Study. Combination antiretroviral therapy and duration of pregnancy. AIDS 2000, 14:2913-2920.
• [21]European Collaborative Study: Exposure to antiretroviral therapy in utero or early life: the health of uninfected children born to HIV infected women. J Acquir Immune Defic Syndr 2003, 32:380-387.
• [22]Cotter AM, Garcia AG, Duthely ML, Luke B, O’Sullivan MJ: Is antiretroviral therapy during pregnancy associated with an increased risk of preterm delivery, low birth weight, or stillbirth? J Infect Dis 2006, 193:195-201.
• [23]Powis KM, Kitch D, Ogwu A, Hughes MD, Lockman S, Leidner J, et al.: Increased Risk of Preterm Delivery Among HIV Infected Women Randomized to Protease Versus Nucleoside Reverse Transcriptase Inhibitor-Based HAART During Pregnancy. J Infect Dis 2011, 204:506-514.
• [24]Szyld E, Warley EM, Freimanis L, et al.: Maternal antiretroviral drugs during pregnancy and infant low birth weight and preterm birth. AIDS 2006, 20:2345-2353.
• [25]Kourtis AP, Schmid CH, Jamieson DJ, Lau J: Use of antiretroviral therapy in pregnant HIV-infected women and the risk of premature delivery: a meta analysis. AIDS 2007, 21:607-615.
• [26]Patel K, Shapiro DE, Brogly SB, et al.: Prenatal protease inhibitor use and risk of preterm birth among HIV-infected women initiating antiretroviral drugs during pregnancy. JID 2010, 201:1035-1044.
• [27]Ezechi OC, Fasubaa OB, Kalu BKE, Nwokoro CA, Obiesie LO: Caesarean Delivery: Why the aversion. Trop J Obstet Gynaecol 2004, 21(2):164-167.