Thompson Kathryn D, Meyers David J, Lee Yoojin, Cu-Uvin Susan, Wilson Ira B
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.
Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA.
Womens Health Rep (New Rochelle). 2022 Jan 4;3(1):1-9. doi: 10.1089/whr.2021.0068. eCollection 2022.
Women living with human immunodeficiency virus (WLHIV) may face additional challenges and differential birth outcomes when compared with women without human immunodeficiency virus (HIV). There is limited research to date studying birth outcomes among a nationally representative sample of WLHIV. This study compares stillbirth and prematurity rates between HIV-positive (HIV+) and HIV-negative (HIV-) mothers in the Medicaid program. We used 12 years (2001-2012) of Medicaid Analytic eXtract data. We included Medicaid claims from the 14 states with the highest prevalence of HIV: California, Florida, Georgia, Illinois, Louisiana, Massachusetts, Maryland, North Carolina, New Jersey, New York, Ohio, Pennsylvania, Texas, and Virginia. Primary outcomes were stillbirth and preterm birth. We used logistic regression models adjusting for age, race, Medicaid coverage, eligibility, substance use, rurality, comorbidities, and state fixed effects to compare differences in rates for women with and without HIV. Our study included a total of 33,078 HIV+ and 7,663,758 HIV- pregnancies from Medicaid enrollees between 2001 and 2012. The proportions of stillbirths and preterm births were higher for HIV+ when compared with HIV- mothers (0.9% vs. 0.7% and 8.0% vs. 6.6%, < 0.0001). After adjusting for covariates, being HIV+ was not significantly associated with both stillbirth (odds ratio [OR]: 1.05) or prematurity (OR: 1.01). Black race was a strong independent predictor of both stillbirth and prematurity (OR: 1.99 and 1.51, < 0.01). Rurality and substance abuse were not associated with either outcome. After adjustment for relevant covariates, maternal HIV infection was not associated with increased rates of stillbirth or preterm birth in the Medicaid program in the United States. It is imperative that we understand and eliminate the clinical, social, and contextual factors that are responsible for the strong association between black race and poor perinatal outcomes that we observe.
与未感染人类免疫缺陷病毒（HIV）的女性相比，感染人类免疫缺陷病毒的女性（WLHIV）可能面临更多挑战和不同的分娩结局。迄今为止，针对全国具有代表性的感染HIV女性样本的分娩结局的研究有限。本研究比较了医疗补助计划中HIV阳性（HIV+）和HIV阴性（HIV-）母亲的死产率和早产率。我们使用了12年（2001 - 2012年）的医疗补助分析提取数据。我们纳入了HIV患病率最高的14个州的医疗补助申请数据：加利福尼亚州、佛罗里达州、佐治亚州、伊利诺伊州、路易斯安那州、马萨诸塞州、马里兰州、北卡罗来纳州、新泽西州、纽约州、俄亥俄州、宾夕法尼亚州、得克萨斯州和弗吉尼亚州。主要结局是死产和早产。我们使用逻辑回归模型，对年龄、种族、医疗补助覆盖范围、资格、药物使用、农村地区、合并症和州固定效应进行调整，以比较感染和未感染HIV的女性在发生率上的差异。我们的研究共纳入了2001年至2012年间医疗补助参保者的33,078例HIV+妊娠和7,663,758例HIV-妊娠。与HIV-母亲相比，HIV+母亲的死产和早产比例更高（0.9%对0.7%以及8.0%对6.6%，P < 0.0001）。在对协变量进行调整后，HIV+与死产（优势比[OR]：1.05）或早产（OR：1.01）均无显著关联。黑人种族是死产和早产的强有力独立预测因素（OR：1.99和1.51，P < 0.01）。农村地区和药物滥用与这两种结局均无关联。在美国医疗补助计划中，对相关协变量进行调整后，母亲HIV感染与死产率或早产率升高无关。我们必须了解并消除那些导致我们所观察到的黑人种族与不良围产期结局之间强烈关联的临床、社会和背景因素。
