Alger L S, Farley J J, Robinson B A, Hines S E, Berchin J M, Johnson J P
Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore.
Obstet Gynecol. 1993 Nov;82(5):787-96.
To assess the influence of human immunodeficiency virus (HIV) infection on pregnancy outcome and the effect of pregnancy on the short-term course of HIV infection.
Pregnant women with identified risk factors for HIV infection but without AIDS were tested serologically for HIV antibodies. Seropositive women were compared to seronegative patients with similar risk factors and demographic characteristics at enrollment, at delivery, and 6-8 weeks postpartum. One hundred one seropositive and 97 seronegative subjects were evaluated for symptoms or physical manifestations of HIV infection; evidence of immune dysfunction; historical, physical, or laboratory evidence of related infections; and maternal and neonatal outcome. Both groups were compared to the entire obstetric population delivering at the University of Maryland Hospital during 1 year.
There was a significant reduction in reported risk behaviors in both groups during pregnancy as compared to the period before pregnancy (P < .001). The majority of women in both groups were asymptomatic, but seropositive women were more likely to have a history or physical evidence of condylomata (13 versus 4%; P < .05) and higher temperatures on admission to the labor suite (98.6 +/- 1.0 versus 98.3 +/- 0.8F; P = .02). Seropositive women were not at greater risk for antepartum medical complications. Only one woman developed an AIDS-defining opportunistic infection. Although hematologic indices in seropositive women were abnormal, these did not progress over the course of pregnancy. At delivery, seropositive women were more likely to receive antibiotics (25 versus 10%; P = .006) and less likely to have an episiotomy (25 versus 40%; P = .03), but obstetric outcome was unaffected. Neonatal status was independent of antibody status.
Our findings support a growing body of evidence that pregnancy has no discernible effect on the early progression of HIV disease in asymptomatic women, and infection does not influence perinatal outcome.
评估人类免疫缺陷病毒（HIV）感染对妊娠结局的影响以及妊娠对HIV感染短期病程的影响。
对有HIV感染风险因素但未患艾滋病的孕妇进行HIV抗体血清学检测。将血清学阳性的女性与入组时、分娩时及产后6 - 8周具有相似风险因素和人口统计学特征的血清学阴性患者进行比较。对101名血清学阳性和97名血清学阴性受试者评估HIV感染的症状或体征；免疫功能障碍的证据；相关感染的病史、体征或实验室证据；以及母婴结局。将两组与马里兰大学医院1年内分娩的所有产科人群进行比较。
与妊娠前相比，两组在妊娠期间报告的危险行为均显著减少（P <.001）。两组中的大多数女性均无症状，但血清学阳性的女性更有可能有尖锐湿疣的病史或体征（13%对4%；P <.05），且进入产房时体温更高（98.6 +/- 1.0华氏度对98.3 +/- 0.8华氏度；P =.02）。血清学阳性的女性产前发生医疗并发症的风险并不更高。只有一名女性发生了艾滋病界定的机会性感染。尽管血清学阳性女性的血液学指标异常，但在妊娠过程中并未进展。分娩时，血清学阳性的女性更有可能接受抗生素治疗（25%对10%；P =.006），且进行会阴切开术的可能性较小（25%对40%；P =.03），但产科结局未受影响。新生儿状况与抗体状态无关。
我们的研究结果支持越来越多的证据表明，妊娠对无症状女性HIV疾病的早期进展没有明显影响，且感染不影响围产期结局。
