Kourtis Athena P, Bansil Pooja, McPheeters Melissa, Meikle Susan F, Posner Samuel F, Jamieson Denise J
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
AIDS. 2006 Sep 11;20(14):1823-31. doi: 10.1097/01.aids.0000244201.11006.1c.
The literature on whether HIV infection and its complex antiretroviral treatments confer a higher risk for adverse pregnancy outcomes is controversial.
We compared rates of hospitalization for select morbidities among HIV-infected and uninfected pregnant women in the USA.
Using data from the 1994-2003 Nationwide Inpatient Sample, we used descriptive statistics and multivariate logistic regression to examine socio-demographic characteristics, morbidity outcomes and time trends.
There were approximately 6000 hospitalizations per year of HIV-infected pregnant women in the USA. HIV-infected women were more likely to be hospitalized in urban hospitals, in the South, have Medicaid as the expected payer, have longer hospitalizations and incur higher charges than uninfected women. Hospitalizations for major puerperal sepsis, genitourinary infections, influenza, bacterial infections, preterm labor/delivery, and liver disorders were more frequent among pregnant HIV-infected women than their uninfected counterparts. However, rates of pre-eclampsia and antepartum hemorrhage were not significantly different. While rates of inpatient mortality and various infectious conditions decreased between 1994 and 2003, the rate of gestational diabetes increased among HIV-infected pregnant women.
HIV-infected pregnant women in the USA continue to be at higher risk for morbidity and adverse obstetric outcomes. With the introduction of antiretroviral therapy, rates of most of the conditions examined have either decreased or remained stable, hence current antiretroviral regimens do not seem to be associated with major adverse pregnancy outcomes on a population basis. The increase in gestational diabetes among HIV-infected women may be associated, in part, with antiretroviral therapy and merits further attention.
关于HIV感染及其复杂的抗逆转录病毒治疗是否会增加不良妊娠结局风险的文献存在争议。
我们比较了美国感染HIV和未感染HIV的孕妇中特定疾病的住院率。
利用1994 - 2003年全国住院患者样本的数据，我们使用描述性统计和多变量逻辑回归来研究社会人口学特征、发病结局和时间趋势。
美国每年约有6000名感染HIV的孕妇住院。与未感染的女性相比，感染HIV的女性更有可能在南方的城市医院住院，预期支付方为医疗补助，住院时间更长且费用更高。感染HIV的孕妇因主要产褥期败血症、泌尿生殖系统感染、流感、细菌感染、早产/分娩和肝脏疾病住院的频率高于未感染的孕妇。然而，子痫前期和产前出血的发生率没有显著差异。虽然1994年至2003年间住院死亡率和各种感染性疾病的发生率有所下降，但感染HIV的孕妇中妊娠期糖尿病的发生率有所上升。
美国感染HIV的孕妇仍然面临更高的发病风险和不良产科结局风险。随着抗逆转录病毒疗法的引入，大多数所研究疾病的发生率要么下降要么保持稳定，因此目前的抗逆转录病毒治疗方案在总体上似乎与主要不良妊娠结局无关。感染HIV的女性中妊娠期糖尿病发生率的上升可能部分与抗逆转录病毒治疗有关，值得进一步关注。
