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Thompson KD, Meyers DJ, Lee Y, Cu-Uvin S, Wilson IB. HIV-Positive and HIV-Negative Women with Medicaid Have Similar Rates of Stillbirth and Preterm Birth. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:1-9. [PMID: 35136871 PMCID: PMC8812497 DOI: 10.1089/whr.2021.0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 04/12/2023]
Abstract
Introduction: Women living with human immunodeficiency virus (WLHIV) may face additional challenges and differential birth outcomes when compared with women without human immunodeficiency virus (HIV). There is limited research to date studying birth outcomes among a nationally representative sample of WLHIV. This study compares stillbirth and prematurity rates between HIV-positive (HIV+) and HIV-negative (HIV-) mothers in the Medicaid program. Methods: We used 12 years (2001-2012) of Medicaid Analytic eXtract data. We included Medicaid claims from the 14 states with the highest prevalence of HIV: California, Florida, Georgia, Illinois, Louisiana, Massachusetts, Maryland, North Carolina, New Jersey, New York, Ohio, Pennsylvania, Texas, and Virginia. Primary outcomes were stillbirth and preterm birth. We used logistic regression models adjusting for age, race, Medicaid coverage, eligibility, substance use, rurality, comorbidities, and state fixed effects to compare differences in rates for women with and without HIV. Results: Our study included a total of 33,078 HIV+ and 7,663,758 HIV- pregnancies from Medicaid enrollees between 2001 and 2012. The proportions of stillbirths and preterm births were higher for HIV+ when compared with HIV- mothers (0.9% vs. 0.7% and 8.0% vs. 6.6%, p < 0.0001). After adjusting for covariates, being HIV+ was not significantly associated with both stillbirth (odds ratio [OR]: 1.05) or prematurity (OR: 1.01). Black race was a strong independent predictor of both stillbirth and prematurity (OR: 1.99 and 1.51, p < 0.01). Rurality and substance abuse were not associated with either outcome. Conclusions: After adjustment for relevant covariates, maternal HIV infection was not associated with increased rates of stillbirth or preterm birth in the Medicaid program in the United States. It is imperative that we understand and eliminate the clinical, social, and contextual factors that are responsible for the strong association between black race and poor perinatal outcomes that we observe.
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Affiliation(s)
- Kathryn D. Thompson
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- *Address correspondence to: Kathryn D. Thompson, Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA,
| | - David J. Meyers
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Susan Cu-Uvin
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
- Providence/Boston Center for AIDS Research (CFAR), Providence, Rhode Island, USA
| | - Ira B. Wilson
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
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Townsend CL, de Ruiter A, Peters H, Nelson-Piercy C, Tookey P, Thorne C. Pregnancies in older women living with HIV in the UK and Ireland. HIV Med 2016; 18:507-512. [PMID: 27862854 DOI: 10.1111/hiv.12469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the study was to compare maternal characteristics and pregnancy outcomes in women aged < 40 years and ≥ 40 years in a large unselected population of HIV-positive women delivering in the UK and Ireland between 2000 and 2014. METHODS Comprehensive population-based surveillance data on all HIV-positive pregnant women and their children seen for care in the UK and Ireland are collected through the National Study of HIV in Pregnancy and Childhood. All singleton and multiple pregnancies reported by the end of June 2015 resulting in live birth or stillbirth to women diagnosed with HIV infection before delivery and delivering in 2000-2014 were included. Logistic regression models were fitted in analyses examining the association between older maternal age and specific outcomes (preterm delivery and stillbirth). RESULTS Among 15 501 pregnancies in HIV-positive women, the proportion in older women (≥ 40 years) increased from 2.1% (73 of 3419) in 2000-2004 to 8.9% (510 of 5748) in 2010-2014 (P < 0.001). Compared with pregnancies in younger women, those in older women were more likely to result in multiple birth (3.0 vs. 1.9% in younger women; P = 0.03), stillbirth (adjusted odds ratio 2.39; P = 0.004) or an infant with a chromosomal abnormality (1.6 vs. 0.2%, respectively; P < 0.001). However, there was no increased risk of preterm delivery, low birth weight or mother-to-child HIV transmission among older mothers. CONCLUSIONS There has been a significant increase over time in the proportion of deliveries to women living with HIV aged ≥ 40 years, which has implications for pregnancy management, given their increased risk of multiple births, stillbirth and chromosomal anomalies, as also apparent in the general population.
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Affiliation(s)
- C L Townsend
- Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK
| | - A de Ruiter
- Guys & St Thomas' NHS Foundation Trust, London, UK
| | - H Peters
- Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK
| | | | - P Tookey
- Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK
| | - C Thorne
- Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK
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Xiao PL, Zhou YB, Chen Y, Yang MX, Song XX, Shi Y, Jiang QW. Association between maternal HIV infection and low birth weight and prematurity: a meta-analysis of cohort studies. BMC Pregnancy Childbirth 2015; 15:246. [PMID: 26450602 PMCID: PMC4599647 DOI: 10.1186/s12884-015-0684-z] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 10/04/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To assess the association between maternal human immunodeficiency virus (HIV) infection and low birth weight (LBW)/prematurity (PTD), we conducted a meta-analysis of cohort studies of HIV infected and uninfected women. METHODS Several English and Chinese databases were searched (updated to May 2015) to find the studies reporting infant outcomes associated with exposure to maternal HIV infection during pregnancy. Relevant articles were manually selected based on several inclusion and exclusion criteria. RESULTS Fifty-two cohort studies including 15,538 (for LBW) and 200,896 (for PTD) HIV infected women met the inclusion criteria. There was significant heterogeneity among studies for maternal HIV infection associated with LBW/PTD (I(2) = 71.7%, P < 0.05, and I(2) = 51.8%, P < 0.05 for LBW and PTD, respectively). The meta-analysis demonstrated that the maternal HIV infection was significantly associated with both LBW (pooled odds ratio (OR): 1.73, 95% confidence interval (CI): 1.64, 1.82, P < 0.001) and PTD (pooled OR: 1.56, 95% CI: 1.49, 1.63, P < 0.001). No significant difference in the relationship between maternal HIV infection and adverse pregnancy outcomes was detected among the groups of different study periods. HIV infected women were at slightly higher risk of LBW in developing countries compared with women in developed countries (OR: 2.12 (95% CI: 1.81, 2.48) vs. 1.75 (95% CI: 1.44, 2.12)). Antiretroviral drugs usage did not significantly change the associations of maternal HIV exposure with LBW and PTD. CONCLUSIONS HIV infected women were at higher risk of having a low birth weight infant or a preterm delivery infant compared with uninfected women. Such associations did not change significantly over time or were not significantly affected by the usage of antiretroviral drugs.
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Affiliation(s)
- Peng-Lei Xiao
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
| | - Yi-Biao Zhou
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
| | - Yue Chen
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8 M5, Canada.
| | - Mei-Xia Yang
- Xuhui Center for Disease Prevention and Control, 50 Yongchuan Road, Xuhui District, Shanghai, 200032, China.
| | - Xiu-Xia Song
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
| | - Yan Shi
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
| | - Qing-Wu Jiang
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
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Liuzzi G, Pinnetti C, Floridia M, Tamburrini E, Masuelli G, Dalzero S, Sansone M, Giacomet V, Degli Antoni AM, Guaraldi G, Meloni A, Maccabruni A, Alberico S, Portelli V, Ravizza M. Pregnancy Outcomes in HIV-Infected Women of Advanced Maternal Age. HIV CLINICAL TRIALS 2014; 14:110-9. [DOI: 10.1310/hct1403-110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Short CES, Taylor GP. Antiretroviral therapy and preterm birth in HIV-infected women. Expert Rev Anti Infect Ther 2014; 12:293-306. [PMID: 24502750 DOI: 10.1586/14787210.2014.885837] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The use of combination antiretroviral therapy for the prevention of mother to child transmission of HIV infection has achieved vertical HIV transmission rates of <1%. The use of these drugs is not without risk to the mother and infant. Pregnant women with HIV-infection are at high risk of preterm birth (PTB <37 weeks), with 2-4-fold the risk of uninfected women. There is accumulating evidence that certain combinations are associated with higher rates of PTB that others or no antiretroviral treatment. Understanding the pathogenesis of PTB in this group of women will be essential to target preventative strategies in the face of increasing HIV prevalence and rapidly expanding mother-to-child-transmission prevention programmes.
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Affiliation(s)
- Charlotte-Eve S Short
- Section of Infectious Diseases, Imperial College London, Wright Fleming Institute, St Mary's Hospital Campus, Norfolk Place, London, W2 1PG, UK
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Salihu HM, Mogos MF, August EM, DeJoy S, de la Cruz C, Alio AP, Marty PJ. HIV infection and its impact on fetal outcomes among women of advanced maternal age: a propensity score weighted matching approach. AIDS Res Hum Retroviruses 2013; 29:581-7. [PMID: 23074988 DOI: 10.1089/aid.2012.0242] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Advanced maternal age (AMA) and HIV status have been investigated separately for their influence on infant outcomes. Both are associated with adverse fetal growth outcomes, including low birth weight (LBW) and preterm birth (PTB). However, the impact of the cooccurrence of these factors in relation to birth outcomes remains relatively understudied. We analyzed Florida hospital discharge data linked to vital records. The study population consisted of women who had a singleton live birth between 1998 and 2007 (N=1,687,176). The exposure variables were HIV infection and maternal age, while the outcomes of interest were LBW, PTB, and small for gestational age (SGA). We matched HIV-positive women to HIV-negative women on selected variables using propensity scores. To approximate relative risks, we computed adjusted odds ratios (AOR) and 95% confidence intervals (CI) generated from logistic regression models and accounted for the matched design using the generalized estimating equations framework. After adjusting for demographic variables, clinical conditions, and route of birth, the risks of LBW, PTB, and SGA remained significant for HIV-positive women, regardless of age. HIV-positive women of AMA (≥35 years) were more likely to have infants of LBW (AOR=1.73, 95% CI=1.37-2.18), PTB (AOR=1.35, 95% CI: 1.06-1.71), and SGA (AOR=1.52, 95% CI=1.22-1.89), compared to uninfected mothers of younger age (<35 years). For women of advanced age, HIV positivity elevates their risk for LBW and PTB. The interplay of HIV status and age should be considered by healthcare providers when determining appropriate interconception strategies for women and their families.
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Affiliation(s)
- Hamisu M. Salihu
- Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa Florida
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida
| | - Mulubrhan F. Mogos
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida
| | - Euna M. August
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida
| | - Sharon DeJoy
- Department of Health, West Chester University, West Chester, Pennsylvania
| | - Cara de la Cruz
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida
| | - Amina P. Alio
- Department of Community and Preventive Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Phillip J. Marty
- USF Health Office of Research, University of South Florida, Tampa, Florida
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