Lehloa Amohelang J, Kalk Emma, Davies Mary-Ann, Nyemba Dorothy, Mehta Ushma, Malaba Thokozile, Petro Gregory, Boulle Andrew, Myer Landon, Madlala Hlengiwe P
Centre for Integrated Data and Epidemiological Research, School of Public Health, University of Cape Town, Cape Town, South Africa.
Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Falmouth Building, Anzio Road, Observatory , Cape Town , Western Cape , 7925, South Africa.
BMC Pregnancy Childbirth. 2025 Sep 2;25(1):924. doi: 10.1186/s12884-025-08086-x.
Despite improved health and survival due to lifelong antiretroviral therapy (ART), women living with HIV (WHIV) still face lower life expectancy, partly due to increased non-communicable disease (NCD) risk. Both HIV and NCDs are linked to adverse birth outcomes, yet data on their combined impact are limited. We investigated NCD burden by HIV status and compared adverse birth outcomes in pregnant WHIV only versus HIV-NCD comorbidity in Cape Town, South Africa.
Pregnant WHIV (n = 479) and without HIV (n = 510) were enrolled and prospectively followed for pregnancy outcome. Weight and height measurements were serially collected by a study nurse, and diagnoses of hypertension and diabetes mellitus (DM) were made by healthcare providers as part of routine care (ANC). Birth outcomes were abstracted from health records. Proportions described adverse outcomes between groups. Logistic regression was used to estimate associations between HIV and HIV-NCD with small for gestational age (SGA), large for gestational age (LGA), preterm delivery (PTD), low birthweight (LBW), and high birthweight (HBW) (reference: group with neither HIV nor NCDs).
Among 989 pregnant women, 48% (n = 479) with HIV (median age 29 years, IQR 25-34), the prevalence of obesity (BMI ≥ 30 kg/m) was 43%, hypertension 15% and DM 2%. The NCD prevalence did not differ by HIV status. HIV co-occurred with obesity in 31% of pregnancies, with hypertension in 5% and with DM in 0.2%. HIV with hypertension and HIV with hypertension and obesity were associated with increased odds of PTD compared to those with neither HIV-NCD (aOR 3.03, 95% CI 1.01, 8.05 and aOR 2.67, 95% CI 1.08, 6.23, respectively). However, HIV and obesity together were associated with lower odds of SGA (aOR 0.39, 95% CI 0.16, 0.97). Likewise, in women without HIV, obesity protected against SGA and LBW, but hypertension increased PTD and LBW.
There was no difference in the prevalence of NCD in pregnant women by HIV status. Increased risk of adverse birth outcomes was demonstrated with concurrent NCD regardless of HIV status. Integration of NCD screening and management within ANC could minimise excess adverse outcomes in high HIV burden settings.
尽管终身抗逆转录病毒疗法（ART）改善了健康状况并提高了生存率，但感染艾滋病毒的女性（WHIV）的预期寿命仍然较低，部分原因是非传染性疾病（NCD）风险增加。艾滋病毒和非传染性疾病都与不良分娩结局有关，但关于它们综合影响的数据有限。我们调查了按艾滋病毒感染状况划分的非传染性疾病负担，并比较了南非开普敦仅感染艾滋病毒的孕妇与合并感染艾滋病毒和非传染性疾病的孕妇的不良分娩结局。
纳入感染艾滋病毒的孕妇（n = 479）和未感染艾滋病毒的孕妇（n = 510），并对妊娠结局进行前瞻性随访。研究护士连续收集体重和身高测量数据，医疗服务提供者在常规护理（产前检查，ANC）中对高血压和糖尿病（DM）进行诊断。从健康记录中提取分娩结局。用比例描述组间的不良结局。采用逻辑回归估计艾滋病毒和艾滋病毒合并非传染性疾病与小于胎龄儿（SGA）、大于胎龄儿（LGA）、早产（PTD）、低出生体重（LBW）和高出生体重（HBW）之间的关联（参考：既未感染艾滋病毒也未患非传染性疾病的组）。
在989名孕妇中，48%（n = 479）感染艾滋病毒（中位年龄29岁，四分位间距25 - 34岁），肥胖（BMI≥30 kg/m²）患病率为43%，高血压患病率为15%，糖尿病患病率为2%。非传染性疾病患病率不因艾滋病毒感染状况而异。在31%的妊娠中，艾滋病毒与肥胖并存，5%与高血压并存，0.2%与糖尿病并存。与既未感染艾滋病毒也未患非传染性疾病的孕妇相比，感染艾滋病毒合并高血压以及感染艾滋病毒合并高血压和肥胖的孕妇早产几率增加（调整后的比值比分别为3.03，95%置信区间1.01，8.05和2.67，95%置信区间1.08，6.23）。然而，艾滋病毒与肥胖共同作用与小于胎龄儿几率降低有关（调整后的比值比0.39，95%置信区间0.16，0.97）。同样，在未感染艾滋病毒的女性中，肥胖可预防小于胎龄儿和低出生体重，但高血压会增加早产和低出生体重的几率。
按艾滋病毒感染状况划分，孕妇中非传染性疾病患病率无差异。无论艾滋病毒感染状况如何，合并非传染性疾病都会增加不良分娩结局的风险。在产前检查中整合非传染性疾病筛查和管理可将艾滋病毒高负担地区的额外不良结局降至最低。
