Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave 37-121 CHS, Los Angeles, CA, 90095, USA.
Preventive Medicine Program, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Curr HIV/AIDS Rep. 2021 Feb;18(1):73-86. doi: 10.1007/s11904-020-00539-6. Epub 2021 Jan 5.
The development of non-communicable diseases (NCDs) in pregnant women living with HIV can be a harbinger of future NCD-related morbidity and mortality. This review focuses on the NCDs that complicate pregnancy and the postpartum period, including hypertensive complications, hyperglycemic disorders, excessive gestational weight gain, and bone mineral density losses. For each disease process, we explore the role of HIV as a possible driver of excess risk, the immediate consequences of these complications on pregnancy outcomes and maternal and infant health, and possible implications for long-term women's health.
Countries with the highest burden of HIV also shoulder a high burden of NCDs that complicate pregnancy, including hypertensive disorders, hyperglycemic disorders, weight gain, and osteopenia. This double burden of disease is a significant public health threat for reproductive-age women, with the potential for serious short- and long-term consequences for both women and their infants. Additionally, as the global first-line antiretroviral therapy regimens increasingly include integrase inhibitors, unhealthy weight gain associated with this drug class poses additional risk for NCD-related pregnancy complications and their persistence postpartum. Further research is needed to better define prevalence of NCD complications in pregnancy, elucidate HIV-specific and traditional factors associated with poor outcomes, and to develop interventions to reduce risk and avoid downstream complications in those at highest risk.
艾滋病毒感染者孕妇中非传染性疾病（NCD）的发展可能预示着未来与 NCD 相关的发病率和死亡率。本综述重点关注妊娠和产后期间使病情复杂化的 NCD，包括高血压并发症、高血糖障碍、妊娠体重过度增加和骨密度损失。对于每种疾病过程，我们探讨了 HIV 作为过度风险的可能驱动因素的作用、这些并发症对妊娠结局以及母婴健康的直接影响，以及对长期妇女健康的可能影响。
艾滋病毒负担最高的国家也承担着使妊娠复杂化的 NCD 的沉重负担，包括高血压疾病、高血糖障碍、体重增加和骨质疏松症。这种双重疾病负担对育龄妇女构成了重大公共卫生威胁，对妇女及其婴儿都有严重的短期和长期后果的潜在风险。此外，随着全球一线抗逆转录病毒治疗方案越来越多地包括整合酶抑制剂，与该药物类别相关的不健康体重增加对与 NCD 相关的妊娠并发症及其产后持续存在带来了额外的风险。需要进一步研究以更好地定义妊娠中 NCD 并发症的患病率，阐明与不良结局相关的 HIV 特异性和传统因素，并制定干预措施，以降低高危人群的风险并避免下游并发症。
