Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.
Section of Virology, Department of Infectious Disease, Imperial College London, London, UK.
J Int AIDS Soc. 2023 Apr;26(4):e26078. doi: 10.1002/jia2.26078.
The prevalence of gestational diabetes (GD) is increasing globally. While universal risk factors for GD are reasonably well understood, questions remain regarding risks for women living with HIV (WLWH). We aimed to describe GD prevalence, evaluate associated maternal risk factors and assess specific birth outcomes in WLWH in the UK and Ireland.
We analysed all pregnancies (≥24 weeks' gestation) in women diagnosed with HIV before delivery, reported to the UK-based Integrated Screening Outcomes Surveillance Service between 2010 and 2020. Every report of GD was considered as a case. A multivariable logistic regression model, adjusted for women with more than one pregnancy fitted with generalized estimating equations (GEE) assessed the effect of independent risk factors.
There were 10,553 pregnancies in 7916 women, of which 460 (4.72%) pregnancies had reported GD. Overall, the median maternal age was 33 years (Q1:29-Q3:37), and 73% of pregnancies were in Black African women. WLWH with GD (WLWH-GD) were older (61% vs. 41% aged ≥35 years, p < 0.001) and more likely to be on treatment at conception (74% vs. 64%, p < 0.001) than women without GD. WLWH-GD were more likely to have a stillbirth (odds ratio [OR]: 5.38, 95% CI: 2.14-13.5), preterm delivery (OR: 2.54, 95% CI: 1.95-3.32) and fetal macrosomia (OR: 1.14, 95% CI: 1.04-1.24). Independent risk factors for GD included estimated year of delivery (GEE-adjusted odds ratio [GEE-aOR]: 1.14, 95% CI: 1.10-1.18), advanced maternal age (≥35 years) (GEE-aOR: 2.87, 95% CI: 1.54-5.34), Asian (GEE-aOR: 2.63, 95% CI: 1.40-4.63) and Black African (GEE-aOR: 1.55, 95% CI: 1.13-2.12) ethnicity. Timing and type of antiretroviral therapy showed no evidence of a relationship with GD in multivariable analyses; however, women with a CD4 count ≤350 cells/μl were 27% less likely to have GD than women with CD4 counts >350 cells/μl (GEE-aOR: 0.73, 95% CI: 0.50-0.96).
GD prevalence increased over time among WLWH but was not significantly different from the general population. Maternal age, ethnicity and CD4 count were risk factors based on available data. Stillbirth and preterm delivery were more common in WLWH-GD than other WLWH over the study period. Further studies are required to build upon these results.
全球妊娠期糖尿病（GD）的患病率正在上升。虽然 GD 的普遍危险因素已经得到了很好的理解，但对于感染艾滋病毒的妇女（WLWH）的风险仍存在疑问。我们旨在描述英国和爱尔兰 WLWH 中的 GD 患病率，评估相关的产妇危险因素，并评估特定的出生结局。
我们分析了 2010 年至 2020 年间在英国综合筛查结局监测服务中报告的所有（≥24 周妊娠）在分娩前诊断出 HIV 的妇女的妊娠情况。每例 GD 报告均被视为一个病例。使用广义估计方程（GEE）拟合具有多个妊娠的妇女的多变量逻辑回归模型调整了独立风险因素的影响。
共有 7916 名妇女的 10553 例妊娠，其中 460 例（4.72%）妊娠报告有 GD。总体而言，产妇的中位年龄为 33 岁（Q1：29-Q3：37），73%的妊娠发生在黑非洲裔妇女中。与没有 GD 的妇女相比，患有 GD 的 WLWH（WLWH-GD）年龄更大（61% vs. 41%年龄≥35 岁，p<0.001），并且在受孕时更有可能接受治疗（74% vs. 64%，p<0.001）。WLWH-GD 更有可能发生死胎（比值比[OR]：5.38，95%CI：2.14-13.5）、早产（OR：2.54，95%CI：1.95-3.32）和胎儿巨大儿（OR：1.14，95%CI：1.04-1.24）。GD 的独立危险因素包括估计的分娩年份（GEE 调整后的比值比[GEE-aOR]：1.14，95%CI：1.10-1.18）、高龄（≥35 岁）（GEE-aOR：2.87，95%CI：1.54-5.34）、亚洲人（GEE-aOR：2.63，95%CI：1.40-4.63）和黑非洲人（GEE-aOR：1.55，95%CI：1.13-2.12）种族。在多变量分析中，抗逆转录病毒治疗的时间和类型没有证据表明与 GD 相关；然而，与 CD4 计数>350 个/μl 的妇女相比，CD4 计数≤350 个/μl 的妇女 GD 的可能性低 27%（GEE-aOR：0.73，95%CI：0.50-0.96）。
WLWH 中的 GD 患病率随着时间的推移而增加，但与一般人群相比并无显著差异。基于现有数据，产妇年龄、种族和 CD4 计数是危险因素。在研究期间，WLWH-GD 的死产和早产发生率高于其他 WLWH。需要进一步的研究来建立在此结果之上。
