He D, Pu J, Liu W X, Zhang Y, Sun L L, Song X
Sichuan Provincial Hospital for Women and Children, Chengdu 610045, China.
West China Second University Hospital, Sichuan University, Chengdu 610041, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2020 Oct 10;41(10):1686-1691. doi: 10.3760/cma.j.cn112338-20191225-00914.
To explore the influencing factors on perinatal mortality of pregnant women with HIV infection to reduce the mother-to-child transmission in Sichuan province. In this study, 4 786 perinatal infants of the HIV-infected pregnant women were included. Related data on perinatal epidemiology was reported by all the 183 medical and health care institutions where the HIV prevention of mother-to-child transmission program was initiated in 2005-2016. Univariate (2) test and multivariate logistic regression methods were used to analyze the perinatal mortality outcomes and influencing factors. The overall perinatal mortality rate was 25.7‰ (123/4 786) among HIV-infected pregnant women, with annual downwarding trend (trend (2)=32.220, =0.000). Perinatal mortality rate appeared the highest ((2)=4.130, =0.042), with more fetal deaths and stillbirths and less early neonatal death within 7 days in Liangshan county ((2)=29.626, =0.000). Results from the multivariate logistic regression analysis showed that fewer pregnant numbers would contribute to the, lower perinatal mortality rate (1-2 pregnancies =0.417, 95: 0.184-0.943; 3-4 pregnancies =0.447, 95: 0.223-0.895). Perinatal deaths were more likely to be prevented if LPV/r protease inhibitor-based triple antiviral therapy was provided (=0.530, 95: 0.285- 0.986) or delivery was taken place in the hospital (hospital of municipal-level and above =0.222, 95:0.098-0.499; county-level hospital =0.282, 95: 0.166-0.480; township-level hospital =0.134, 95: 0.031-0.586) among HIV-infected pregnant women. However, premature delivery or neonatal asphyxia would increase the risk of perinatal mortality (premature delivery =8.285, 95: 5.073-13.533; neonatal asphyxia =9.624, 95: 4.625-20.028). The perinatal mortality rate of HIV-infected pregnant women appeared significantly higher than that in the province or the whole country. Strategies involving LPV/r-based triple antiviral therapy, promotion of hospital delivery, reducing the incidence rates of premature deliveries and neonatal asphyxia, should be strengthened.
为探讨影响四川省HIV感染孕妇围产儿死亡的因素，以降低母婴传播。本研究纳入了4786例HIV感染孕妇的围产儿。2005 - 2016年启动预防母婴传播项目的183家医疗卫生机构上报了围产儿流行病学相关数据。采用单因素（2）检验和多因素logistic回归方法分析围产儿死亡结局及影响因素。HIV感染孕妇的总体围产儿死亡率为25.7‰（123/4786），呈逐年下降趋势（趋势（2）=32.220，=0.000）。凉山州围产儿死亡率最高（（2）=4.130，=0.042），死胎、死产较多，7天内早期新生儿死亡较少（（2）=29.626，=0.000）。多因素logistic回归分析结果显示，妊娠次数越少，围产儿死亡率越低（1 - 2次妊娠=0.417，95%可信区间：0.184 - 0.943；3 - 4次妊娠=0.447，95%可信区间：0.223 - 0.895）。对于HIV感染孕妇，采用基于洛匹那韦/利托那韦蛋白酶抑制剂的三联抗病毒治疗（=0.530，95%可信区间：0.285 - 0.986）或在医院分娩（市级及以上医院=0.222，95%可信区间：0.098 - 0.499；县级医院=0.282，95%可信区间：0.166 - 0.480；乡镇级医院=0.134，95%可信区间：0.031 - 0.586）更有可能预防围产儿死亡。然而，早产或新生儿窒息会增加围产儿死亡风险（早产=8.285，95%可信区间：5.073 - 13.533；新生儿窒息=9.624，95%可信区间：4.625 - 20.028）。HIV感染孕妇的围产儿死亡率显著高于全省或全国水平。应加强基于洛匹那韦/利托那韦的三联抗病毒治疗、促进住院分娩、降低早产和新生儿窒息发生率等策略。
