ABSTRACT

Background: Recent studies show that ART is associated with an adverse birth outcome in HIV-infected women.

Aim: To compare rates of low birthweight (LBW) and preterm birth (PTB) between HIV-infected women receiving lifelong ART and HIV-uninfected women giving birth in low- and high-risk settings in Malawi.

Methods: This observational, registry study was conducted from January 2016 to August 2017 in one large, tertiary referral hospital and four primary healthcare (PHC) facilities in Blantyre, Malawi. Women who delivered singleton live births or stillbirths of ≥20 weeks gestation were included in the analysis. Descriptive and stratified analyses were conducted using χ² tests and multivariable logistic models to control for maternal age, gravidity and health facility.

Results: A total of 14,233 births were included in the analysis (7715 from the tertiary hospital and 6518 from PHC facilities). In the univariable analysis, there were no differences in rates of LBW (6.7% vs 6.4%) and PTB (42.5% vs 42.0%) between HIV-infected and -uninfected women delivering in PHC facilities. However, differences in LBW were significantly higher in HIV-infected women in multivariable analysis (LBW aOR 1.40, 95% CI 1.01–1.95). Rates of LBW and PTB were significantly higher in HIV-infected women than in uninfected women delivering at the tertiary hospital (LBW 17.6% vs 13.2%, aOR 1.53, 95% CI 1.27–1.85; PTB 28.2% vs 24.9%, aOR 1.37, 95% CI 1.17–1.60)

Conclusion: Rates of adverse birth outcomes are significantly higher in HIV-infected women than in HIV-uninfected women, and this is more apparent in high-risk hospital settings than in low-risk PHC settings.

摘要

背景：最近的研究表明，ART 与 HIV 感染妇女的不良分娩结果有关。

目的：比较在马拉维接受终生抗逆转录病毒治疗的 HIV 感染妇女和在低风险和高风险环境中分娩的未感染 HIV 妇女的低出生体重 (LBW) 和早产 (PTB) 率。

方法：这项观察性登记研究于 2016 年 1 月至 2017 年 8 月在马拉维布兰太尔的一家大型三级转诊医院和四家初级保健 (PHC) 设施中进行。分析中包括了单胎活产或妊娠 ≥ 20 周死产的妇女。描述和分层分析采用χ进行^2个测试和多变量logistic模型来控制产妇年龄，孕次和卫生设施。

结果：共有 14,233 名新生儿被纳入分析（7715 名来自三级医院，6518 名来自 PHC 机构）。在单变量分析中，在初级卫生保健机构分娩的 HIV 感染和未感染女性的 LBW（6.7%对6.4%）和 PTB（42.5%对42.0%）的发生率没有差异。然而，在多变量分析中，感染 HIV 的女性的 LBW 差异显着更高（LBW aOR 1.40，95% CI 1.01-1.95）。感染 HIV 的女性 LBW 和 PTB 的发生率显着高于在三级医院分娩的未感染女性（LBW 17.6% vs 13.2%，aOR 1.53，95% CI 1.27–1.85；PTB 28.2% vs 24.9%，aOR 1.37， 95% CI 1.17–1.60)

结论：感染 HIV 的女性的不良分娩结局发生率显着高于未感染 HIV 的女性，这在高风险医院环境中比在低风险 PHC 环境中更为明显。