南非夸祖鲁-纳塔尔省 HIV-1 感染与胎膜早破及妊娠结局的关系
Preterm prelabour rupture of membranes (PPROM) and pregnancy outcomes in association with HIV-1 infection in KwaZulu-Natal, South Africa.
机构信息
Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
出版信息
BMC Pregnancy Childbirth. 2020 Apr 9;20(1):204. doi: 10.1186/s12884-020-02911-1.
BACKGROUND
SubSaharan Africa has a disproportionate burden of HIV and preterm births (PTB). We hypothesized that PTB in HIV-1 infected women are more likely a result of prelabour rupture of membranes (PROM) and could lead to worse birth outcomes than HIV-uninfected women. We also hypothesized that PPROM increased the risk of mother-to-child transmission (MTCT) of HIV-1. Current clinical management protocols for PPROM do not include a differential treatment plan for HIV-infected women.
METHODS
The maternity register at a regional hospital in a high HIV-burden district in South Africa was reviewed to identify all preterm births over a 3 month-period in 2018. We determined the incidence of PPROM using predefined criteria. Maternal age, parity, previous pregnancy complications, antenatal care, body mass index, history of smoking or alcohol, HIV infection and syphilis were computed on chi-square contingency tables to determine risk of PPROM. Overall pregnancy outcomes that included mode of delivery, fetal survival, birth weight, gestational age and newborn apgar scores were compared between HIV-infected and HIV-uninfected women whose pregnancies were complicated by PPROM. HIV-exposed newborns are routinely tested at birth for HIV by PCR.
RESULTS
A total of 1758 deliveries were recorded for Jan-Mar, 2018, and 295 (16.8%) were preterm. Maternity charts were retrieved for 236 (80.0%) PTB; 47 of PTB (19.9%; 95%CI 15.0-25.6) were further complicated by PROM which translates to 2.7% (95%CI 1.9-3.4) of all deliveries. None of the risk variables including HIV-positive status (48.9% vs 47.6%) were different between PPROM and non-PPROM groups and the majority of women were receiving cART (94.7 and 92.0%). There were no differences in the proportion of low birth weight (RR 1.2 95%CI 0.6-2.1) or severe preterm birth (RR 1.6; 95%CI 0.9-2.9) between HIV-infected and HIV-uninfected women whose pregnancies were complicated by PPROM. None of the 22 HIV-exposed newborns in the PPROM group were HIV-infected at birth.
CONCLUSION
The PPROM incidence is not higher among HIV-infected women and our findings suggest that HIV-infected women who are virally suppressed on cART and presenting with PPROM are less likely to transmit HIV to their infants and do not have worse birth outcomes than HIV-uninfected women.
背景
撒哈拉以南非洲地区 HIV 和早产（PTB）负担过重。我们假设 HIV-1 感染妇女的 PTB 更可能是胎膜早破（PROM）的结果，并且可能导致比 HIV 未感染妇女更差的分娩结局。我们还假设胎膜早破增加了 HIV-1 的母婴传播（MTCT）风险。目前针对胎膜早破的临床管理方案并不包括针对 HIV 感染妇女的差异化治疗方案。
方法
对南非高 HIV 负担地区的一家地区医院的产妇登记处进行了回顾性分析，以确定 2018 年 3 个月期间所有早产病例。我们使用预设标准确定胎膜早破的发生率。通过卡方列联表计算产妇年龄、产次、既往妊娠并发症、产前保健、体重指数、吸烟或饮酒史、HIV 感染和梅毒史，以确定胎膜早破的风险。比较 HIV 感染和未感染妇女的胎膜早破妊娠的总体妊娠结局，包括分娩方式、胎儿存活率、出生体重、胎龄和新生儿 Apgar 评分。HIV 暴露新生儿在出生时常规通过 PCR 检测 HIV。
结果
2018 年 1 月至 3 月共记录了 1758 次分娩，其中 295 次（16.8%）为早产。对 236 例（80.0%） PTB 的产妇病历进行了检索；其中 47 例（19.9%；95%CI 15.0-25.6）进一步并发胎膜早破，这相当于所有分娩的 2.7%（95%CI 1.9-3.4）。胎膜早破组和非胎膜早破组之间，包括 HIV 阳性状态在内的大多数风险变量（48.9% vs 47.6%）均无差异，大多数妇女正在接受 cART（94.7%和 92.0%）。HIV 感染和未感染妇女的胎膜早破妊娠的低出生体重（RR 1.2；95%CI 0.6-2.1）或严重早产（RR 1.6；95%CI 0.9-2.9）比例均无差异。胎膜早破组中 22 例 HIV 暴露新生儿均未在出生时感染 HIV。
结论
HIV 感染妇女的胎膜早破发生率并不更高，我们的研究结果表明，接受 cART 病毒抑制且出现胎膜早破的 HIV 感染妇女将 HIV 传播给婴儿的可能性较低，并且其分娩结局并不比 HIV 未感染妇女更差。
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