Maternal human immunodeficiency virus infection and pregnancy outcome

Abstract

Objective: A longitudinal study to determine the natural history of HIV-1 infection in pregnancy, infancy and early childhood was carried out in Ndola, Zambia.

Design: Prospective study.

Setting: Kabushi and Chifubu clinics.

Subjects: A total of 965 women attending antenatal care were screened for anti-HIV antibodies using the Welcozyme test. All reactive sera were confirmed by Western Blot. One hundred and fifty seropositive pregnant women (cases) with their age and parity matched pregnant control (seronegative) were recruited into the study. They were followed up through delivery.

Main outcome measure: personal characteristics, socio-economic and other risk factors.

Results: The prevalence of anti HIV-1 antibodies among the 965 women was 15.5pc. Results of baseline data between the two groups of women indicate significant differences (p < 0.05) in the following variables; marital status, outcome of last pregnancy, whether last child is still alive, history of herpes zoster, lymphadenopathy, dermatitis, oral thrush and mean haemoglobin level. There were no differences in the incidence of abortions, stillbirths and neonatal deaths. However, the mean birth weight of babies born out of seropositive women was significantly lower than babies of seronegative women.

Conclusion: It is concluded that HIV-1 infection in pregnancy is associated with low birth weight.

PIP: Data on 130 HIV-1 infected pregnant women were compared with data on 150 HIV-1 negative pregnant women to determine the effect of HIV-1 infection on pregnancy outcomes. All the women were recruited while seeking prenatal services at Chifubu and Kabushi clinics in Ndola, Zambia, during 1991-1993. None of the HIV-1 infected women had AIDS. The HIV- 1 prevalence rate for the recruited pregnant women was 15.5%. The socioeconomic characteristics of the women in both suburbs were similar. Yet, pregnant women at Chifubu were more likely to be HIV-1 positive than those at Kabushi (p 0.001). The proximity to the border with Zaire and the higher inward and outward migration rates in Chifubu may contribute to the higher HIV-1 prevalence rate in Chifubu. HIV-1 infected women were more likely than controls to have a history of Herpes zoster, cervical lymphadenopathy, axillary lymphadenopathy, skin rash, and oral thrush (p 0.05). They were less likely than controls to be married, to have the outcome of their last birth be a live birth, and to have their last child still be alive (p = 0.01). HIV-1 pregnant women had a lower hemoglobin level and smaller newborns than controls (10.3 vs. 10.9 g % and 2.76 vs. 3.03 kg, respectively; p 0.03). When the researchers controlled for gestation, there was no difference in mean birth weights between the groups. Both groups had similar perinatal mortality outcomes (1 stillbirth each and 2 neonatal deaths each). The most significant finding is that HIV-1 infection in pregnancy contributes to low birth weight.