Option B+ for prevention of vertical HIV transmission has no influence on adverse birth outcomes in a cross-sectional cohort in Western Uganda

BMC Pregnancy and Childbirth

Research Article

John Rubaihayo¹  Stefanie Theuring²  Eva M. Rempis²  Alexandra Schnack²  Vera Braun²  Sarah Decker²  Gundel Harms²  Nazarius Mbona Tumwesigye³  Priscilla Busingye⁴ 

[1] Department of Public Health, Mountains of the Moon University, Fort Portal, Kabarole, Uganda;Institute of Tropical Medicine and International Health, Charité- University Medicine, Augustenburger Platz 1, 13353, Berlin, Germany;School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda;The Holy Family Virika Hospital, Fort Portal, Kabarole, Uganda;

关键词: Human immunodeficiency virus type 1 (HIV-1);    Antiretroviral therapy (ART);    Prevention of mother-to-child-transmission (PMTCT);    Option B+;    Adverse pregnancy (birth) outcomes;    Stillbirth;    Preterm delivery;    Small for gestational age;    Uganda;   

DOI  :  10.1186/s12884-017-1263-2

 received in 2016-03-01, accepted in 2017-02-28,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundWhile most Sub-Saharan African countries are now implementing the WHO-recommended Option B+ protocol for prevention of vertical HIV transmission, there is a lack of knowledge regarding the influence of Option B+ exposure on adverse birth outcomes (ABOs). Against this background, we assessed ABOs among delivering women in Western Uganda.MethodsA cross-sectional, observational study was performed within a cohort of 412 mother-newborn-pairs in Virika Hospital, Fort Portal in 2013. The occurrence of stillbirth, pre-term delivery, and small size for gestational age (SGA) was analysed, looking for influencing factors related to HIV-status, antiretroviral drug exposure and duration, and other sociodemographic and clinical parameters.ResultsAmong 302 HIV-negative and 110 HIV-positive women, ABOs occurred in 40.5%, with stillbirth in 6.3%, pre-term delivery in 28.6%, and SGA in 12.2% of deliveries. For Option B+ intake (n = 59), no significant association was found with stillbirth (OR 0.48, p = 0.55), pre-term delivery (OR 0.97, p = 0.92) and SGA (OR 1.5, p = 0.3) compared to seronegative women. Women enrolled on antiretroviral therapy (ART) before conception (n = 38) had no different risk for ABOs than women on Option B+ or HIV-negative women. Identified risk factors for stillbirth included lack of formal education, poor socio-economic status, long travel distance, hypertension and anaemia. Pre-term delivery risk was increased with poor socio-economic status, primiparity, Malaria and anaemia. The occurrence of SGA was influenced by older age and Malaria.ConclusionIn our study, women on Option B+ showed no difference in ABOs compared to HIV-negative women and to women on ART. We identified several non-HIV/ART-related influencing factors, suggesting an urgent need for improving early risk assessment mechanisms in antenatal care through better screening and triage systems. Our results are encouraging with regard to continued universal scale-up of Option B+ and ART programmes.

【 授权许可】

CC BY   
© The Author(s). 2017