Ng Ryan, Macdonald Erin M, Yudin Mark H, Bayoumi Ahmed M, Loutfy Mona R, Raboud Janet, Masinde Khatundi-Irene, Tharao Wangari E, Brophy Jason, Glazier Richard H, Antoniou Tony
Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.
CMAJ Open. 2015 Oct 19;3(4):E360-5. doi: 10.9778/cmajo.20140112. eCollection 2015 Oct-Dec.
Maternal placental syndromes are associated with adverse fetal outcomes and maternal cardiovascular disease. However, whether HIV infection increases the risk of maternal placental syndromes is unknown. Our objective was to compare the risk of maternal placental syndromes between women living with and without HIV infection in Ontario.
We conducted a population-based study using health administrative data from Ontario. We identified all pregnancies resulting in a live birth between Apr. 1, 2002, and Mar. 31, 2011; we identified women living with HIV using a validated case-finding algorithm. Our primary composite outcome was maternal placental syndromes, defined as a diagnosis of preeclampsia, eclampsia, placental abruption or placental infarction. We used generalized estimating equations with a logit link function to derive adjusted odds ratios (AORs) and 95% confidence intervals (CI) for the association between HIV infection and maternal placental syndromes.
Data from 1 132 871 pregnancies were available for analysis; 634 (0.06%) of the pregnancies were in women living with HIV. After multivariable adjustment, we found no difference in the risk of maternal placental syndromes between women living with HIV and those without HIV infection (5.8% v. 5.6%; AOR 0.85 [95% CI 0.59-1.21]). An increased risk of maternal placental syndromes was associated with pre-existing diabetes (AOR 1.47 [95% CI 1.39-1.54]), pre-existing hypertension (AOR 4.28 [95% CI 4.15-4.42]) and chronic kidney disease (AOR 1.83 [95% CI 1.61-2.08]).
Women with HIV are not at increased risk of maternal placental syndromes. Our results underscore the importance of optimizing the management of comorbid illness associated with maternal placental syndromes during the prenatal period for all women, irrespective of HIV status.
孕产妇胎盘综合征与不良胎儿结局及孕产妇心血管疾病相关。然而，HIV感染是否会增加孕产妇胎盘综合征的风险尚不清楚。我们的目的是比较安大略省感染HIV和未感染HIV的女性发生孕产妇胎盘综合征的风险。
我们利用安大略省的卫生行政数据进行了一项基于人群的研究。我们确定了2002年4月1日至2011年3月31日期间所有活产的妊娠；我们使用经过验证的病例发现算法确定感染HIV的女性。我们的主要复合结局是孕产妇胎盘综合征，定义为子痫前期、子痫、胎盘早剥或胎盘梗死的诊断。我们使用具有logit链接函数的广义估计方程来推导HIV感染与孕产妇胎盘综合征之间关联的调整优势比（AOR）和95%置信区间（CI）。
1132871例妊娠的数据可供分析；其中634例（0.06%）妊娠的女性感染了HIV。经过多变量调整后，我们发现感染HIV的女性与未感染HIV的女性发生孕产妇胎盘综合征的风险没有差异（5.8%对5.6%；AOR 0.85[95%CI 0.59-1.21]）。孕产妇胎盘综合征风险增加与既往糖尿病（AOR 1.47[95%CI 1.39-1.54]）、既往高血压（AOR 4.28[95%CI 4.15-4.42]）和慢性肾脏病（AOR 1.83[95%CI 1.61-2.08]）相关。
感染HIV的女性发生孕产妇胎盘综合征的风险并未增加。我们的结果强调了在孕期优化所有女性（无论HIV感染状况如何）与孕产妇胎盘综合征相关合并症管理的重要性。
