Fetal Growth Restriction and Clinical Parameters of Newborns from HIV-Infected Romanian Women

Abstract

Background and Objectives: The present study assessed the fetal growth restriction and clinical parameters of both human immunodeficiency virus (HIV)-negative and HIV-positive newborns from HIV-infected mothers in two HIV-acquired immunodeficiency syndrome regional centers (RCs) in Constanta and Craiova, Romania, in order to evaluate the adverse birth-related outcomes. Materials and Methods: These represent a retrospective study conducted between 2008 and 2019, in which 408 pregnant HIV-positive women, 244 from Constanta RC and 164 from Craiova RC, were eligible to participate in the study. Consecutive singleton pregnancies delivered beyond 24 weeks of pregnancy were included. Growth restriction in newborns was defined as the birth weight (BW) being less than the third percentile, or three out of the following: BW < 10th percentile; head circumference (HC) < 10th percentile; birth length (BL) < 10th percentile; prenatal diagnosis of fetal growth restriction; and maternal pregnancy information. Of the 244 newborns delivered in Constanta, RC, 17 were HIV-positive, while in Craiova, RC, of the 164 newborns, 9 were HIV-positive. All HIV-positive women were on combined antiretroviral therapy (cART) during pregnancy, similar to all HIV-positive newborns who received ARTs for the first six weeks. We search for the influence of anthropometrical parameters (i.e., HC, BL, and BW), as well as clinical parameters (i.e., newborn sex and Apgar score) for both HIV-negative and HIV-positive newborns, along with the survival rate of HIV-positive newborns. Results: There were no differences in the sex of the newborns within either group, with more than 50% being boys. Similarly, the Apgar score did not show any statistically significant values between the two groups (i.e., p = 0.544 for HIV-positive newborns vs. p = 0.108 for HIV-negative newborns). Interestingly, our results showed that in Craiova, RC, there was a chance of 2.16 to find an HIV-negative newborn with an HC < 10th percentile and a 2.54 chance to find an HIV-negative newborn with a BL < 10th percentile compared to Constanta, RC, without any significant differences. On the contrary, Constanta, RC, represented a higher risk of death (i.e., 3.049 times, p = 0.0470) for HIV-positive newborns compared to Craiova, RC. Conclusions: Our results support the idea that follow-up of fetal growth restriction should be part of postnatal care in this high-risk population to improve adverse birth-related outcomes.

Keywords: Apgar score; HIV-positive newborns; anthropometrical parameters; birth-related outcomes; fetal growth restriction; fetal length.

Figure 1

Line chart showing comparative trends over time for HIV-negative and HIV-positive newborns in Constanta and Craiova, Regional Centers (RCs). CT HIV+ = HIV-positive newborns from Constanta RC; CT HIV− = HIV-negative newborns from Constanta RC; CV HIV+ = HIV-positive newborns from Craiova RC; CV HIV− = HIV-negative newborns from Craiova RC.

Figure 2

Anthropometric parameters (a) head circumference (HC), (b) birth length (BL), and (c) birth weight (BW) of HIV-positive newborns from the two Regional Centers. P10 = percentile 10.

Figure 3

Anthropometric parameters (a) head circumference (HC), (b) birth length (BL), and (c) birth weight (BW) of HIV-negative newborns from the two Reginal Centers. P10 = percentile 10.

Figure 4

Survival curve of HIV-positive newborns for each RC.