The Impact of ART on Stillbirth and Neonatal Death Among HIV-positive Pregnant Women - Yunnan Province, China, 2013-2022

Abstract

Introduction: This study assessed the impact of antiretroviral therapy (ART) on stillbirth and neonatal mortality and investigated associated risk factors among ‌Human immunodeficiency virus-positive (HIV-positive) pregnant women in Yunnan, China during 2013-2022.

Methods: Data from the National Information System of Integrated Prevention of Mother-to-Child Transmission of HIV, Syphilis, and Hepatitis B Program (PMTCT) were analyzed to determine stillbirth and neonatal mortality rates. Multivariate Poisson regression was employed to identify risk factors associated with stillbirth and neonatal outcomes.

Results: Among 9,563 HIV-positive women with singleton pregnancies in Yunnan Province during 2013-2022, 9,404 (98.34%) received ART during pregnancy, while 159 (1.66%) did not. There were 9,421 live births, 76 stillbirths, and 66 neonatal deaths, yielding a stillbirth rate (SBR) of 8.07‰ and neonatal mortality rate (NMR) of 7.01‰. The SBR was significantly lower in pregnancies where ART was used (P=0.033). Univariate analysis revealed that ART (P=0.009), ethnicity (P=0.012), and antenatal care utilization (P<0.001) were associated with stillbirth and newborn survival. Multivariate Poisson regression identified that six or more antenatal care visits as an independent predictor of survival.

Conclusions: Stillbirth and neonatal mortality rates were elevated among mothers who did not receive ART during pregnancy compared to those who did. These findings emphasize the importance of ART during pregnancy, particularly since several mortality risk factors are amenable to intervention.