Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States of America.
Department of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, MA, United States of America.
PLoS One. 2020 Mar 11;15(3):e0229500. doi: 10.1371/journal.pone.0229500. eCollection 2020.
HIV-infected women on antiretroviral therapy have a higher risk of preterm birth than HIV-uninfected women in Botswana. To better understand the mechanism for preterm birth among HIV-infected women, we evaluated whether mid-trimester cervical length differed by HIV status as cervical shortening is associated with an increased risk for preterm birth.
We conducted a prospective cohort study among pregnant women receiving care at the Scottish Livingstone Hospital in Molepolole, Botswana. Consecutive women referred for routine obstetrical ultrasound were consented and enrolled if between 22w0d and 24w6d by ultrasound biometry. Blinded to maternal HIV status, an obstetrician measured transvaginal cervical length using standardized criteria. Cervical length, as well as the proportion of women with a short cervix (<25mm), were compared among HIV-infected and HIV-uninfected women. The acceptability of transvaginal ultrasound was also evaluated.
Between April 2016 and April 2017, 853 women presenting for obstetric ultrasound were screened, 187 (22%) met eligibility criteria, and 179 (96%) were enrolled. Of those enrolled, 50 (28%) were HIV-infected (86% on antiretroviral therapy), 127 (71%) were HIV-uninfected, and 2 (1%) had unknown HIV status. There was no significant difference in mean cervical length between HIV-infected and HIV-uninfected women (32mm vs 31mm, p = 0.21), or in the proportion with a short cervix (10% vs 14%, p = 0.44). Acceptability data was available for 115 women who underwent a transvaginal ultrasound exam. Of these, 112 of 115 (97%) women deemed the transvaginal scan acceptable.
The increased risk of preterm birth observed among HIV-infected women receiving antiretroviral therapy in Botswana is unlikely associated with mid-trimester cervical shortening. Further research is needed to understand the underlying mechanism for preterm birth among HIV-infected women.
在博茨瓦纳，接受抗逆转录病毒疗法的 HIV 感染妇女早产的风险高于未感染 HIV 的妇女。为了更好地了解 HIV 感染妇女早产的机制，我们评估了中期宫颈长度是否因 HIV 状况而异，因为宫颈缩短与早产风险增加有关。
我们在博茨瓦纳莫莱波洛莱的苏格兰利文斯顿医院对接受护理的孕妇进行了一项前瞻性队列研究。连续接受常规产科超声检查的妇女在超声生物测量中通过超声测量被认为处于 22w0d 至 24w6d 之间时，同意并被纳入研究。在不知道母亲 HIV 状况的情况下，一名产科医生使用标准化标准经阴道测量宫颈长度。比较了 HIV 感染和未感染妇女的宫颈长度以及宫颈较短（<25mm）的妇女比例。还评估了经阴道超声的可接受性。
在 2016 年 4 月至 2017 年 4 月期间，对 853 名接受产科超声检查的妇女进行了筛查，187 名（22%）符合入选标准，179 名（96%）被纳入研究。在纳入的人群中，50 名（28%）为 HIV 感染（86%接受抗逆转录病毒治疗），127 名（71%）为 HIV 未感染，2 名（1%）HIV 状态未知。HIV 感染和未感染妇女的平均宫颈长度无显著差异（32mm 与 31mm，p = 0.21），或宫颈较短的比例（10%与 14%，p = 0.44）。有 115 名接受经阴道超声检查的妇女可提供可接受性数据。在这些妇女中，112/115（97%）的妇女认为经阴道扫描可以接受。
在博茨瓦纳接受抗逆转录病毒治疗的 HIV 感染妇女早产风险增加，这可能与中期宫颈缩短无关。需要进一步研究以了解 HIV 感染妇女早产的潜在机制。
