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Pregnancy outcomes in an observational cohort study of HIV-positive women in Ukraine, 2000-2012

Bagkeris, E; Malyuta, R; Volokha, A; Cortina Borja, M; Bailey, H; Townsend, C; Thorne, C; (2015) Pregnancy outcomes in an observational cohort study of HIV-positive women in Ukraine, 2000-2012. The Lancet HIV , 2 (9) e385-e392. 10.1016/S2352-3018(15)00079-X. Green open access

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Abstract

Background: Women living with HIV are potentially at increased risk of adverse pregnancy outcomes, due to a range of factors, including immunosuppression, use of combination antiretroviral therapy (ART), and injecting drug use. Rates of mother-to-child transmission of HIV in Ukraine have declined to around 2–4%, but little is known about other pregnancy outcomes in this setting. We used data from an observational prospective cohort study to assess pregnancy outcomes among HIV-positive women in Ukraine. Methods: The European Collaborative Study (ECS) in EuroCoord is a continuing cohort study, established in Ukraine in 2000. Eligible women are those with a diagnosis of HIV infection before or during pregnancy (including intrapartum) who deliver liveborn babies at seven sites. Maternal sociodemographic, HIV-related, and delivery (mother and infant) data were collected with study-specific questionnaires. We used Poisson regression models to identify factors associated with preterm delivery (before 37 weeks' gestation) and small weight for gestational age (less than the tenth percentile of weight for gestational age), based on complete cases. Findings: Between January, 2000, and July, 2012, data were collected on 8884 HIV-positive mother and liveborn infant pairs. Median maternal age was 26·5 years (IQR 23·1–30·3). 832 (11%) women had WHO stage 3 or 4 HIV and 1474 (17%) had a history of injecting drug use. 7348 (83%) had received antenatal ART. Among 7435 for whom ART type was available, 4396 (50%) had received zidovudine monotherapy and 2949 (33%) combination ART. Preterm delivery was seen in 780 (9%, 95% CI 8–9) of 8860 births overall and in 77 (9%, 7–11) of 889 babies with small size for gestational age. Factors associated with preterm delivery were history of injecting drug use (adjusted risk ratio 1·64, 95% CI 1·38–1·95), no ART (2·94, 2·43–3·57 vs zidovudine monotherapy), antenatal combination ART (1·40, 1·14–1·73 vs zidovudine monotherapy), WHO stage 4 HIV (2·42, 1·71–3·41 vs WHO stage 1), and being in the most socially deprived group (1·38, 1·11–1·71). Small size for gestational age was associated with history of injecting drug use (adjusted RR 1·39, 95% CI 1·16–1·65), most socially deprived (1·32, 1·09–1·61), no ART (1·60, 1·32–1·94 vs zidovudine monotherapy), and antenatal combination ART (1·33, 1·12–1·60 vs zidovudine monotherapy). Interpretation: Some risk factors for adverse pregnancy outcomes were directly associated with HIV and treatment and others were shared with the general antenatal population. Monitoring of pregnancy outcomes in Ukraine will be important as use of antenatal combination ART increases.

Type: Article
Title: Pregnancy outcomes in an observational cohort study of HIV-positive women in Ukraine, 2000-2012
Location: UK
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/S2352-3018(15)00079-X
Publisher version: http://dx.doi.org/10.1016/S2352-3018(15)00079-X
Language: English
Additional information: © 2015 Elsevier Ltd. This manuscript is made available under a Creative Commons Attribution Non-commercial Non-derivative 4.0 International license (CC BY-NC-ND 4.0). This license allows you to share, copy, distribute and transmit the work for personal and non-commercial use providing author and publisher attribution is clearly stated. Further details about CC BY licenses are available at http://creativecommons.org/ licenses/by/4.0. Access may be initially restricted by the publisher.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept
URI: https://discovery.ucl.ac.uk/id/eprint/1468021
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