Temmerman M, Chomba E N, Ndinya-Achola J, Plummer F A, Coppens M, Piot P
Department of Medical Microbiology, University of Nairobi, Kenya.
Obstet Gynecol. 1994 Apr;83(4):495-501. doi: 10.1097/00006250-199404000-00002.
To study the impact of maternal human immunodeficiency virus type 1 (HIV-1) infection on pregnancy outcome.
Between January 1989 and December 1991, 406 HIV-1-seropositive and 407 HIV-1-seronegative age- and parity-matched pregnant women from Nairobi, Kenya, all at less than 28 weeks' gestation, were recruited into a prospective study of HIV-1 infection in pregnant women and their offspring. Both groups were followed until 6 weeks postpartum.
Three hundred fifteen HIV-1-seropositive women and 311 HIV-1-seronegative controls were followed until delivery. Seropositive women were younger at sexual debut and reported more lifetime partners and more sexually transmitted diseases (STDs) than the seronegative controls. The seropositive women had higher rates of genital ulcer disease (4.7 versus 2.0%; P = .08), genital warts (4.9 versus 2.0%; P = .03), and positive syphilis serology (7.9 versus 3.2%; P < .001), but there were no differences between the groups in isolation rates of Neisseria gonorrhoeae (6.8 versus 7.1%) and Chlamydia trachomatis (11.5 versus 9.0%). Maternal HIV-1 infection was associated with significantly lower birth weight (2913 versus 3072 g; P = .0003) and with prematurity (21.1 versus 9.4%; P < .0001), but not with small for gestational age size (4.2 versus 3.2%; P = .7). The stillbirth rate was higher in seropositive women, yet not statistically significant (3.8 versus 1.9%; P = .2). Women with a CD4 count lower than 30% had a higher risk of preterm delivery (26.3 versus 10.1%; P < .001). Postpartum endometritis was more common in HIV-1-infected women than in seronegative controls (10.3 versus 4.2%; P = .01) and was inversely correlated with the CD4 percentage. No histopathologic placental abnormalities attributable to HIV-1 were detected.
Maternal HIV-1 infection was significantly associated with prematurity and postpartum endometritis, but not with fetal growth retardation. There was a trend toward a higher stillbirth rate in HIV-1-seropositive mothers.
研究孕产妇人类免疫缺陷病毒1型（HIV-1）感染对妊娠结局的影响。
在1989年1月至1991年12月期间，从肯尼亚内罗毕招募了406名HIV-1血清学阳性和407名年龄及产次匹配的HIV-1血清学阴性孕妇，她们均处于妊娠28周以内，被纳入一项关于孕妇及其后代HIV-1感染的前瞻性研究。两组均随访至产后6周。
315名HIV-1血清学阳性妇女和311名HIV-1血清学阴性对照者被随访至分娩。血清学阳性妇女首次性行为的年龄更小，报告的终身性伴侣更多，性传播疾病（STD）也比血清学阴性对照者更多。血清学阳性妇女的尖锐湿疣（4.9%对2.0%；P = 0.03）、梅毒血清学阳性（7.9%对3.2%；P < 0.001）发生率更高，但两组淋病奈瑟菌（6.8%对7.1%）和沙眼衣原体（11.5%对9.0%）的分离率无差异。孕产妇HIV-1感染与出生体重显著降低（2913克对3072克；P = 0.0003）和早产（21.1%对9.4%；P < 0.0001）相关，但与小于胎龄儿无关（4.2%对3.2%；P = 0.7）。血清学阳性妇女的死产率更高，但无统计学意义（3.8%对1.9%；P = 0.2）。CD4细胞计数低于30%的妇女早产风险更高（26.3%对10.1%；P < 0.001）。产后子宫内膜炎在HIV-1感染妇女中比血清学阴性对照者更常见（10.3%对4.2%；P = 0.01），且与CD4百分比呈负相关。未检测到归因于HIV-1的组织病理学胎盘异常。
孕产妇HIV-1感染与早产和产后子宫内膜炎显著相关，但与胎儿生长受限无关。HIV-1血清学阳性母亲死产率有升高趋势。
