Department of Mathematical Sciences, University of Malawi, Zomba, Malawi.
Biostatistics Research Unit, South Africa Medical Research Council, Pretoria, South Africa.
BMC Public Health. 2020 Jun 22;20(1):974. doi: 10.1186/s12889-020-09046-0.
Several studies have shown that maternal HIV infection is associated with adverse pregnancy outcomes such as low birth weight and perinatal mortality. However, the association is conflicted with the effect of antiretroviral therapy (ART) on the pregnancy outcomes and it remains unexamined. If the association is confirmed then it would guide policy makers towards more effective prevention of mother to child HIV transmission interventions. Using methods for matching possible confounders, the objectives of the study were to assess the effect of maternal HIV infection on birth weight and perinatal mortality and to investigate the effect of ART on these two pregnancy outcomes in HIV-infected women.
Data on 4111 and 4759 children, born within five years of the 2010 and 2015-16 Malawi Demographic and Health Surveys (MDHS) respectively, whose mothers had an HIV test result, were analysed. A best balancing method was chosen from a set of covariate balance methods namely, the 1:1 nearest neighbour (NN) matching, matching on the propensity score (PS) and inverse weighting on the PS. HIV and ART data were only available in the MDHS 2010, permitting an assessment of the moderating effect of ART on the association between maternal HIV infection and birth weight and perinatal mortality.
The overall average birth weight was 3227.9g (95% CI: 3206.4, 3249.5) in 2010 and 3226.4g (95%: 3205.6, 3247.2) in 2015-16 and perinatal mortality was 3.8% (95%: 3.2, 4.3) in 2010 and 3.5% (95%: 2.8, 3.8) in 2015-16. The prevalence of HIV among the mothers was 11.1% (95%: 10.1, 12.0) and 9.2% (95% CI: 8.4, 10.1) in 2010 and 2015-16, respectively. In 2010, maternal HIV infection was negatively associated with birth weight (mean= -25.3g, 95% CI:(-95.5, -7.4)) and in 2015-16 it was positively associated with birth weight (mean= 116.3g, 95% CI:(27.8, 204.7)). Perinatal mortality was higher in infants of HIV-infected mothers compared to infants of HIV-uninfected mothers (OR = 1.5, 95% CI:(1.1 - 3.1)) in 2010, while there was no difference in the rate in 2015-16 (OR = 1.0, 95% CI:(0.4, 1.6)). ART was not associated with birth weight, however, it was associated with perinatal mortality (OR=3.9, 95% CI:(1.1, 14.8)).
The study has found that maternal HIV infection had an adverse effect on birth weight and perinatal mortality in 2010. Birth weight was not dependent on ART uptake but perinatal mortality was higher among infants of HIV-infected mothers who were not on ART. The higher birth weight among HIV-infected mothers and similarity in perinatal mortality with HIV-uninfected mothers in 2015-16 may be indicative of successes of interventions within the PMTCT program in Malawi.
多项研究表明，母亲感染 HIV 与低出生体重和围产期死亡率等不良妊娠结局有关。然而，抗逆转录病毒疗法（ART）对妊娠结局的影响与这种关联存在冲突，目前尚未得到证实。如果这种关联得到证实，那么它将指导决策者制定更有效的母婴 HIV 传播干预措施。本研究通过使用匹配可能混杂因素的方法，旨在评估母亲 HIV 感染对出生体重和围产期死亡率的影响，并调查 HIV 感染妇女中 ART 对这两个妊娠结局的影响。
分析了分别于 2010 年和 2015-16 年马拉维人口与健康调查（MDHS）中出生的 4111 名和 4759 名儿童的数据，其母亲的 HIV 检测结果为阳性。从一组协变量平衡方法中选择了一种最佳平衡方法，即 1:1 最近邻（NN）匹配、基于倾向评分（PS）的匹配和基于 PS 的反向加权。仅在 MDHS 2010 年中获得了 HIV 和 ART 数据，这使得能够评估 ART 对母亲 HIV 感染与出生体重和围产期死亡率之间关联的调节作用。
2010 年的平均出生体重为 3227.9g（95%CI：3206.4，3249.5），2015-16 年为 3226.4g（95%：3205.6，3247.2），围产期死亡率分别为 3.8%（95%：3.2，4.3）和 3.5%（95%：2.8，3.8）。母亲 HIV 感染率分别为 11.1%（95%：10.1，12.0）和 9.2%（95%CI：8.4，10.1）。2010 年，母亲 HIV 感染与出生体重呈负相关（均值=-25.3g，95%CI：（-95.5，-7.4）），而 2015-16 年则呈正相关（均值=116.3g，95%CI：（27.8，204.7））。与未感染 HIV 的母亲的婴儿相比，HIV 感染母亲的婴儿围产期死亡率更高（OR=1.5，95%CI：（1.1-3.1）），而在 2015-16 年则没有差异（OR=1.0，95%CI：（0.4，1.6））。ART 与出生体重无关，但与围产期死亡率有关（OR=3.9，95%CI：（1.1，14.8））。
本研究发现，母亲 HIV 感染在 2010 年对出生体重和围产期死亡率有不良影响。出生体重不依赖于 ART 的采用，但未接受 ART 的 HIV 感染母亲的婴儿围产期死亡率更高。2015-16 年 HIV 感染母亲的婴儿出生体重较高且与未感染 HIV 母亲的婴儿的围产期死亡率相似，这可能表明马拉维 PMTCT 项目中的干预措施取得了成功。
