Dos Reis HLB, Araujo KDS, Ribeiro LP, Da Rocha DR, Rosato DP, Passos MRL, Merçon De Vargas PR. Preterm birth and fetal growth restriction in HIV-infected Brazilian pregnant women.
Rev Inst Med Trop Sao Paulo 2016;
57:111-20. [PMID:
25923889 PMCID:
PMC4435008 DOI:
10.1590/s0036-46652015000200003]
[Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 07/24/2014] [Indexed: 01/06/2023] Open
Abstract
Introduction:
Maternal HIV infection and related co-morbidities may have two outstanding
consequences to fetal health: mother-to-child transmission (MTCT) and adverse
perinatal outcomes. After Brazilian success in reducing MTCT, the attention must
now be diverted to the potentially increased risk for preterm birth (PTB) and
intrauterine fetal growth restriction (IUGR).
Objective:
To determine the prevalence of PTB and IUGR in low income, antiretroviral users,
publicly assisted, HIV-infected women and to verify its relation to the HIV
infection stage.
Patients and Methods:
Out of 250 deliveries from HIV-infected mothers that delivered at a tertiary
public university hospital in the city of Vitória, state of Espírito Santo,
Southeastern Brazil, from November 2001 to May 2012, 74 single pregnancies were
selected for study, with ultrasound validated gestational age (GA) and data on
birth dimensions: fetal weight (FW), birth length (BL), head and abdominal
circumferences (HC, AC). The data were extracted from clinical and pathological
records, and the outcomes summarized as proportions of preterm birth (PTB, < 37
weeks), low birth weight (LBW, < 2500g) and small (SGA), adequate (AGA) and
large (LGA) for GA, defined as having a value below, between or beyond the ±1.28
z/GA score, the usual clinical cut-off to demarcate the 10th and 90th
percentiles.
Results:
PTB was observed in 17.5%, LBW in 20.2% and SGA FW, BL, HC and AC in 16.2%, 19.1%,
13.8%, and 17.4% respectively. The proportions in HIV-only and AIDS cases were:
PTB: 5.9 versus 27.5%, LBW: 14.7% versus 25.0%, SGA BW: 17.6% versus 15.0%, BL:
6.0% versus 30.0%, HC: 9.0% versus 17.9%, and AC: 13.3% versus 21.2%; only SGA BL
attained a significant difference. Out of 15 cases of LBW, eight (53.3%) were
preterm only, four (26.7%) were SGA only, and three (20.0%) were both PTB and SGA
cases. A concomitant presence of, at least, two SGA dimensions in the same fetus
was frequent.
Conclusions:
The proportions of preterm birth and low birth weight were higher than the local
and Brazilian prevalence and a trend was observed for higher proportions of SGA
fetal dimensions than the expected population distribution in this small casuistry
of newborn from the HIV-infected, low income, antiretroviral users, and publicly
assisted pregnant women. A trend for higher prevalence of PTB, LBW and SGA fetal
dimensions was also observed in infants born to mothers with AIDS compared to
HIV-infected mothers without AIDS.
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