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Meta-Analysis
. 2013 Oct 4;8(10):e74848.
doi: 10.1371/journal.pone.0074848. eCollection 2013.

HIV and the risk of direct obstetric complications: a systematic review and meta-analysis

Clara Calvert  1 , Carine Ronsmans
Affiliations
Meta-Analysis

HIV and the risk of direct obstetric complications: a systematic review and meta-analysis

Clara Calvert et al. PLoS One. .

Abstract

Background: Women of reproductive age in parts of sub-Saharan Africa are faced both with high levels of HIV and the threat of dying from the direct complications of pregnancy. Clinicians practicing in such settings have reported a high incidence of direct obstetric complications among HIV-infected women, but the evidence supporting this is unclear. The aim of this systematic review is to establish whether HIV-infected women are at increased risk of direct obstetric complications.

Methods and findings: Studies comparing the frequency of obstetric haemorrhage, hypertensive disorders of pregnancy, dystocia and intrauterine infections in HIV-infected and uninfected women were identified. Summary estimates of the odds ratio (OR) for the association between HIV and each obstetric complication were calculated through meta-analyses. In total, 44 studies were included providing 66 data sets; 17 on haemorrhage, 19 on hypertensive disorders, five on dystocia and 25 on intrauterine infections. Meta-analysis of the OR from studies including vaginal deliveries indicated that HIV-infected women had over three times the risk of a puerperal sepsis compared with HIV-uninfected women [pooled OR: 3.43, 95% confidence interval (CI): 2.00-5.85]; this figure increased to nearly six amongst studies only including women who delivered by caesarean (pooled OR: 5.81, 95% CI: 2.42-13.97). For other obstetric complications the evidence was weak and inconsistent.

Conclusions: The higher risk of intrauterine infections in HIV-infected pregnant and postpartum women may require targeted strategies involving the prophylactic use of antibiotics during labour. However, as the huge excess of pregnancy-related mortality in HIV-infected women is unlikely to be due to a higher risk of direct obstetric complications, reducing this mortality will require non obstetric interventions involving access to ART in both pregnant and non-pregnant women.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart of study selection for inclusion in the systematic review.
1After removal of duplicates 2Articles may have been excluded for multiple reasons.
Figure 2
Figure 2. Forest plot showing the strength of association between HIV and obstetric haemorrhage in studies with vaginal deliveries only or included both vaginal deliveries and c-section deliveries.
Figure 3
Figure 3. Forest plot showing the strength of association between HIV and hypertensive diseases of pregnancy.
*Adjusted odds ratio.
Figure 4
Figure 4. Forest plot showing the strength of association between HIV and dystocia.
*Adjusted odds ratio.
Figure 5
Figure 5. Forest plot showing the strength of association between HIV and intrauterine infection.
Figure 6
Figure 6. Forest plot showing the strength of association between HIV and intrauterine infection in studies which only looked at caesarean deliveries.
*Adjusted odds ratio.
Figure 7
Figure 7. Forest plot showing the strength of association between HIV and caesarean section in studies included in this systematic review.
See this image and copyright information in PMC

References

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