Human Immunodeficiency Virus in Pregnancy a Retrospective Study on Maternal and Perinatal Outcomes

Q4 Medicine
Muralikrishnan Nambiar, Nikhil shetty, Athulya sreenivas, Anupama suresh Y, Anjali Suneel
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引用次数: 0

Abstract

Objective:  To assess the maternal and perinatal outcome in pregnant women with HIV infection and the role of Antiretroviral therapy in reducing complications of pregnancy. Methods: A retrospective analysis was conducted on data from HIV-positive mothers receiving antenatal care at a tertiary care center between February 2015 and January 2020. The study examined various adverse pregnancy outcomes in relation to antiretroviral treatment. Statistical analysis employed chi-square and Fisher’s exact tests to determine differences in distribution proportions of patients on ART versus those not on ART across various antenatal and neonatal complications, with significance attributed to p-values <0.05. Results: A total of 155 patients were found to be HIV positive. Out of this 58 were diagnosed before pregnancy and 97 during pregnancy. Miscarriage was seen in one (0.6%) patient on ART and two (1.2%) not on treatment (p-value 0.6). Sixteen (10.3%) patients underwent medical termination of pregnancy (MTP); all were given HIV-positive status and they were all on ART (p-value <0.001). Anemia was seen in eighteen (11.6%) patients out of which 14(9%) were on ART (p-value 0.01). One (0.64%) woman had thrombocytopenia and she was on ART (p-value 1). Two (1.2%) patients on ART had diabetes mellitus (p-value 0.4). One (0.64%) patient who was on ART developed polyhydramnios (p-value 1).  A total of 8 (5.16%) women had hypertensive disorders; out of which 4(2.58%) were on ART (p-value 1). 11(7.09%) patients who were on ART and 6(3.8%) not on ART had preterm labor (p-value 0.2). 12(7.74%) patients who were not on ART had intrauterine growth restriction (IUGR) and 2(1.29%) on ART had IUGR. A total of 6(3.87%) patients had Intrauterine fetal demise (IUFD), of which 3(1.93%) were on ART and 3(1.93%) were not (p-value 1).  Pre-labour rupture of membranes (PROM) was observed in 2(1.29%) women on ART and 11(7.09%) patients not on ART (p-value 0.004). All women (100%) had CD4 counts more than 500. All (100%) babies delivered at our center received antiretroviral therapy either with oral Nevirepine. Almost half the women (51.6%) had vaginal delivery. Almost one-fourth, 41(26.4%) had a cesarean section. All caesareans were done given obstetric indications. There were no instrumental deliveries. Our study had a total of 122 live births. All 122(100%) babies were exclusively breastfed. None of the babies delivered in our center developed HIV on follow up which was done at 6 weeks and 6 months. Nine (5.8%) patients had infections. None of these women were on ART(p-value < 0.001). Conclusion: HIV infection during pregnancy is associated with various adverse outcomes, but ART plays a crucial role in mitigating these risks and preventing mother-to-child HIV transmission. Initiating ART in all HIV-positive mothers and their infants is essential regardless of HIV status. Keywords: anemia, ART, HIV, MTP, Perinatal outcome,  PROM.
妊娠期人类免疫缺陷病毒孕产妇和围产期结局回顾性研究
目的 评估感染艾滋病病毒孕妇的母体和围产期结局,以及抗逆转录病毒疗法在减少妊娠并发症方面的作用。方法对 2015 年 2 月至 2020 年 1 月期间在一家三级护理中心接受产前护理的 HIV 阳性母亲的数据进行了回顾性分析。研究考察了与抗逆转录病毒治疗相关的各种不良妊娠结局。统计分析采用了卡方检验和费雪精确检验来确定接受抗逆转录病毒治疗与未接受抗逆转录病毒治疗的患者在各种产前和新生儿并发症中的分布比例差异,P 值小于 0.05 为差异显著。结果共发现 155 名艾滋病毒阳性患者。其中 58 人在怀孕前被确诊,97 人在怀孕期间被确诊。一名(0.6%)接受抗逆转录病毒疗法的患者流产,两名(1.2%)未接受治疗的患者流产(P 值为 0.6)。16(10.3%)名患者接受了医学终止妊娠(MTP);所有患者均为艾滋病病毒呈阳性,且均接受了抗逆转录病毒疗法(P 值小于 0.001)。有 18 名(11.6%)患者出现贫血,其中 14 名(9%)接受了抗逆转录病毒疗法(P 值为 0.01)。一名妇女(0.64%)患有血小板减少症,她正在接受抗逆转录病毒疗法(P 值为 1)。两名(1.2%)接受抗逆转录病毒疗法的患者患有糖尿病(p 值 0.4)。一名(0.64%)接受抗逆转录病毒疗法的患者出现多胎妊娠(P 值为 1)。 共有 8 名(5.16%)妇女患有高血压,其中 4 名(2.58%)正在接受抗逆转录病毒疗法(p 值 1)。11(7.09%)名接受抗逆转录病毒疗法的患者和 6(3.8%)名未接受抗逆转录病毒疗法的患者有早产现象(P 值为 0.2)。12(7.74%)名未接受抗逆转录病毒疗法的患者患有宫内发育迟缓(IUGR),2(1.29%)名接受抗逆转录病毒疗法的患者患有宫内发育迟缓。共有 6 名(3.87%)患者出现宫内胎儿夭折(IUFD),其中 3 名(1.93%)接受了抗逆转录病毒疗法,3 名(1.93%)未接受抗逆转录病毒疗法(P 值为 1)。 2 名(1.29%)接受抗逆转录病毒疗法的妇女和 11 名(7.09%)未接受抗逆转录病毒疗法的患者出现产前胎膜破裂(PROM)(P 值为 0.004)。所有产妇(100%)的 CD4 细胞计数均超过 500。所有(100%)在本中心分娩的婴儿都接受了抗逆转录病毒疗法,或口服奈韦瑞平。近一半的产妇(51.6%)经阴道分娩。近四分之一的产妇(41 人,占 26.4%)进行了剖腹产。所有的剖腹产都是根据产科指征进行的。没有器械助产。我们的研究共有 122 例活产。所有 122 名婴儿(100%)均为纯母乳喂养。在本中心分娩的婴儿中,没有一人在 6 周和 6 个月的随访中感染艾滋病毒。9名(5.8%)患者受到感染。这些产妇均未接受抗逆转录病毒疗法(P 值小于 0.001)。结论孕期感染艾滋病病毒会导致各种不良后果,但抗病毒疗法在降低这些风险和预防母婴传播艾滋病病毒方面发挥着至关重要的作用。无论 HIV 感染状况如何,对所有 HIV 阳性母婴启动抗逆转录病毒疗法都是至关重要的。关键词:贫血、抗逆转录病毒疗法、HIV、MTP、围产期结局、PROM。
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来源期刊
Indonesian Journal of Obstetrics and Gynecology
Indonesian Journal of Obstetrics and Gynecology Medicine-Pathology and Forensic Medicine
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审稿时长
24 weeks
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