University of Washington, Seattle, Washington, USA.
Kenyatta National Hospital, Nairobi, Kenya.
AIDS. 2022 Jun 1;36(7):1007-1019. doi: 10.1097/QAD.0000000000003215. Epub 2022 Mar 4.
The aim of this study was to understand predictors of adverse pregnancy outcomes (APOs) among women on antiretroviral treatment (ART).
A longitudinal cohort.
Participants from the Mobile WAChX trial were evaluated for APOs, including stillbirth (fetal death at ≥20 weeks' gestation), preterm birth (PTB, livebirth at <37 weeks' gestation,) and neonatal death (NND, ≤28 days after live birth). Predictors were determined by univariable and multivariable Cox proportional hazards and log-binomial models.
Among 774 women included, median age was 27 years and 29.0% had unsuppressed HIV viral load (>1000 copies/ml) at enrollment. Half (55.1%) started ART prepregnancy, 89.1% on tenofovir-based regimens. Women with depression had a higher risk of stillbirth (adjusted hazard ratio [aHR] 2.93, 95% confidence interval (95% CI) 1.04-8.23), and women with lower social support score had higher risk of late stillbirth (aHR 11.74, 2.47-55.86). Among 740 livebirths, 201 (27.2%) were preterm and 22 (3.0%) experienced NND. PTB was associated with unsuppressed maternal viral load (adjusted prevalence ratio [aPR] 1.28, 95% CI 1.02-1.61), intimate partner violence (IPV) in pregnancy (aPR 1.94, 95% CI 1.28-2.94), and history of any sexually transmitted infection (STI) (aPR 1.63, 95% CI 1.06-2.51). NND was associated with PTB (aPR 2.53, 95% CI 1.10-5.78) and STI history (aPR 4.25, 95% CI 1.39-13.06). Most associations retained significance in the subgroup of women with viral suppression.
Maternal viremia during pregnancy predicted PTB as did IPV, lower education, and STI history, while psychosocial stressors predicted stillbirth. Implementing mental health services, ART adherence, partner support, and routine STI screening and treatment could reduce APOs among women with HIV in sub-Saharan Africa settings.
本研究旨在了解接受抗逆转录病毒治疗（ART）的女性不良妊娠结局（APO）的预测因素。
纵向队列研究。
对 Mobile WAChX 试验中的参与者进行 APO 评估，包括死胎（妊娠 20 周及以上的胎儿死亡）、早产（PTB，妊娠 37 周及以下的活产）和新生儿死亡（NND，活产后 28 天内死亡）。通过单变量和多变量 Cox 比例风险和对数二项式模型确定预测因素。
在纳入的 774 名女性中，中位年龄为 27 岁，29.0%在入组时 HIV 病毒载量未得到抑制（>1000 拷贝/ml）。一半（55.1%）在妊娠前开始接受 ART，89.1%使用基于替诺福韦的方案。患有抑郁症的女性死胎风险更高（调整后的危险比 [aHR] 2.93，95%置信区间 [95%CI] 1.04-8.23），社会支持评分较低的女性晚死胎风险更高（aHR 11.74，95%CI 2.47-55.86）。在 740 例活产中，201 例（27.2%）早产，22 例（3.0%）新生儿死亡。未抑制的母体病毒载量（调整后的患病率比[aPR] 1.28，95%CI 1.02-1.61）、妊娠期间的亲密伴侣暴力（IPV）（aPR 1.94，95%CI 1.28-2.94）和既往性传播感染（STI）史（aPR 1.63，95%CI 1.06-2.51）与 PTB 相关。NND 与 PTB 相关（aPR 2.53，95%CI 1.10-5.78）和 STI 史（aPR 4.25，95%CI 1.39-13.06）相关。大多数关联在病毒抑制的女性亚组中仍然具有统计学意义。
妊娠期间的母体病毒血症预测 PTB，IPV、较低的教育程度和 STI 史也有预测作用，而心理社会压力因素预测死胎。在撒哈拉以南非洲地区，实施心理健康服务、ART 依从性、伴侣支持以及常规性传播感染筛查和治疗，可能会降低 HIV 女性的 APO。
