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Zanré N, Carvalho S, Elwood C, Côté HCF, Kakkar F, Boucher M, Money D, Boucoiran I. Factors associated with HIV viral load control in the early postpartum period - a Canadian prospective cohort study. AIDS Care 2024:1-8. [PMID: 38500011 DOI: 10.1080/09540121.2024.2325082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024]
Abstract
Despite success in managing HIV during pregnancy, challenges remain around sustained adherence with antiretroviral therapy (ART), and the suboptimal viral load (VL) suppression during the postpartum period. The objective of this study was to compare VL levels at delivery and during the postpartum period and assess factors associated with lack of viral suppression during the postpartum period in Canada. We combined data from two Canadian prospective cohorts, which included 286 HIV-positive women (352 pregnancies) who delivered between 2012 and 2020. Delivery VL, postpartum VL, and potential factors associated with an undetectable VL (<50 copies/mL), 2-18 weeks after delivery were assessed. To account for the correlation between multiple pregnancies from the same woman, generalized estimating equations were used to assess bivariate associations. Ninety-nine per cent of pregnant women were on ART during pregnancy compared to 93% during the postpartum period. Of those with available VL results (n = 214 pregnancies), 94% of women achieved an undetectable VL at delivery compared to 87% during the postpartum period. The postpartum period is a challenging time for ART use and VL control. Qualitative studies are needed to better understand these challenges and guide us in designing adequate interventions.
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Affiliation(s)
- Nadège Zanré
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
| | - Sabrina Carvalho
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada
- Mother and Children Infectious Disease Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Chelsea Elwood
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital & Health Centre, Vancouver, BC, Canada
| | - Hélène C F Côté
- Women's Health Research Institute, BC Women's Hospital & Health Centre, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Fatima Kakkar
- Mother and Children Infectious Disease Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Marc Boucher
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
- Mother and Children Infectious Disease Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Deborah Money
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital & Health Centre, Vancouver, BC, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
- Mother and Children Infectious Disease Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
- School of Public Health, University of Montreal, Montreal, QC, Canada
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Shaulov T, Zanré N, Phillips S, Lapensée L. The association between the type of progesterone supplementation and miscarriage risk in women who have had a positive pregnancy test following embryo transfer: a retrospective cohort study. Arch Gynecol Obstet 2023; 308:569-577. [PMID: 37156908 DOI: 10.1007/s00404-023-07047-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE The purpose of this study was to identify if switching from intramuscular (IM) to vaginal progesterone compared to staying on IM progesterone after a positive pregnancy test following embryo transfer (ET) is associated with miscarriage risk. METHODS A retrospective cohort study was performed in a private university-affiliated fertility clinic and included women aged 18-50 years with a positive pregnancy test following ET. The two groups studied were: women who stayed on IM progesterone following a positive pregnancy test and those who switched to vaginal progesterone after a positive test. The main outcome measured was risk of miscarriage < 24 weeks gestation as a proportion of non-biochemical pregnancies. RESULTS 1988 women were included in the analysis. Among the baseline characteristics, the presence of prior miscarriages as well as prior failed ETs, and frozen cycles (vs fresh) as type of transfer were associated with IM progesterone use (p values ≤ 0.01). As per miscarriage risk < 24 weeks, 22.4% (274/1221) of patients in the IM progesterone group experienced a miscarriage compared with 20.7% (159/767) in the vaginal progesterone group (OR 0.90; 95% CI 0.73-1.13). A multivariable logistic regression model revealed an adjusted OR (aOR) of 0.97 (95% CI 0.77-1.22). CONCLUSION This study suggests that switching from IM to vaginal progesterone after a positive pregnancy test following an ET is not associated with miscarriage risk. Considering that IM progesterone imposes substantial discomfort, this study offers reassurance and some flexibility in treatment protocols. Further prospective studies are necessary to corroborate the results of this study.
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Affiliation(s)
- Talya Shaulov
- OVO Fertility Clinic, 8000 Decarie Blvd, Montreal, QC, H4P 2S4, Canada.
- Department of Obstetrics and Gynecology, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada.
| | - Nadège Zanré
- Department of Obstetrics and Gynecology, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Simon Phillips
- OVO Fertility Clinic, 8000 Decarie Blvd, Montreal, QC, H4P 2S4, Canada
| | - Louise Lapensée
- OVO Fertility Clinic, 8000 Decarie Blvd, Montreal, QC, H4P 2S4, Canada
- Department of Obstetrics and Gynecology, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
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Niyibizi J, Zanré N, Mayrand MH, Trottier H. Association Between Maternal Human Papillomavirus Infection and Adverse Pregnancy Outcomes: Systematic Review and Meta-Analysis. J Infect Dis 2021; 221:1925-1937. [PMID: 32022858 DOI: 10.1093/infdis/jiaa054] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/04/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Experimental studies provide evidence of the harmful effect of human papillomavirus (HPV) infection on pregnancy, but observational studies are inconclusive. We systematically assessed the association between HPV and adverse pregnancy outcomes. METHODS We searched electronic databases up to December 1, 2019. We included observational studies on the association between HPV and adverse pregnancy outcomes. We conducted a random-effect meta-analysis for each outcome and assessed heterogeneity between studies. RESULTS From 3034 citations, we included 38 studies and quantitatively synthesized 36 studies. Human papillomavirus was significantly associated with preterm birth (age-adjusted odds ratio [aOR], 1.50; 95% confidence interval [CI], 1.19-1.88), preterm premature rupture of membranes (aOR, 1.96; 95% CI, 1.11-3.45), premature rupture of membranes (aOR, 1.42; 95% CI, 1.08-1.86), intrauterine growth restriction (aOR, 1.17; 95% CI, 1.01-1.37), low birth weight (aOR, 1.91; 95% CI, 1.33-2.76), and fetal death (aOR, 2.23; 95% CI, 1.14-4.37). No significant association was found for spontaneous abortion (aOR, 1.14; 95% CI, 0.40-3.22) and pregnancy-induced hypertensive disorders (aOR, 1.24; 95% CI, 0.80-1.92). Most of the studies were of moderate or low quality, and substantial between-studies heterogeneity remained unexplained. CONCLUSIONS We found a consistent and significant association between HPV and preterm birth and preterm premature rupture of membranes. Human papillomavirus may also be associated with intrauterine growth restriction, low birth weight, and fetal death, but findings are limited by suboptimal control of biases.
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Affiliation(s)
- Joseph Niyibizi
- Université de Montréal, School of Public Health, Department of Social and Preventive Medicine, Montreal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, CRCHUM, Montreal, Quebec, Canada
| | - Nadège Zanré
- Université de Montréal, Faculty of Medicine, Montreal, Quebec, Canada
| | - Marie-Hélène Mayrand
- Université de Montréal, School of Public Health, Department of Social and Preventive Medicine, Montreal, Quebec, Canada.,Research Centre of University of Montreal Hospital Centre, CRCHUM, Montreal, Quebec, Canada.,Université de Montréal, Department of Obstetrics and Gynecology, Montreal, Quebec, Canada
| | - Helen Trottier
- Université de Montréal, School of Public Health, Department of Social and Preventive Medicine, Montreal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, CRCHUM, Montreal, Quebec, Canada
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Shaulov T, Zanré N, Phillips S, Lapensée L. THE ASSOCIATION BETWEEN TYPE OF PROGESTERONE SUPPLEMENTATION AND MISCARRIAGE RISK IN WOMEN WITH A POSITIVE PREGNANCY TEST FOLLOWING EMBRYO TRANSFER: A RETROSPECTIVE COHORT STUDY. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Niyibizi J, Zanré N, Mayrand MH, Trottier H. The association between adverse pregnancy outcomes and maternal human papillomavirus infection: a systematic review protocol. Syst Rev 2017; 6:53. [PMID: 28284227 PMCID: PMC5346269 DOI: 10.1186/s13643-017-0443-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 02/24/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is the most prevalent genital infection, especially in young women of reproductive age. In vitro and animal model experiments provide compelling evidence of the harmful effect of HPV on pregnancy outcomes, but results from epidemiologic studies are inconclusive. We aim to determine the strength of the relationship between adverse pregnancy outcomes (APO) and HPV infection and assess its consistency across studies, by systematically reviewing the literature. METHODS The search strategy has been developed on the basis of the PICOS framework: Population (pregnant women); Exposure (HVP infection confirmed by HPV testing); Comparator (pregnant women without HPV infection); Outcomes (miscarriage, spontaneous preterm birth, low birth weight, preterm premature rupture of membranes, pregnancy-induced hypertensive disorders and intrauterine growth restriction) and Study design (observational studies). We will search three information sources: (1) electronic databases (MEDLINE, EMBASE, and EBM Reviews databases); (2) Grey literature (Google Scholar and Web of Science conference proceedings); and (3) citing and cited articles of included studies. Two reviewers (JN, NZ) will independently and in duplicate screen identified articles, select eligible studies, and extract data. Discrepancies will be resolved by consensus and otherwise by discussion with the other authors (MHM, HT). Quality of included studies will be assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. We will narratively synthesize extracted data whether meta-analysis is conducted or not. Meta-analysis of each outcome will be performed, and where appropriate, an average measure of association will be computed. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess and grade the strength of confidence in cumulative estimate. DISCUSSION Comprehensive and high-quality evidence of a negative effect of HPV on pregnancy outcomes might be an additional motivation for HPV vaccination. Absence of such relationship could dispel anxiety and reassure HPV-infected pregnant women and clinicians. Findings of a poor level of confidence will allow identification of current knowledge gaps on HPV-pregnancy outcome relationship that need further research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016033425.
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Affiliation(s)
- Joseph Niyibizi
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Pavilion 7101, Avenue du Parc, Montreal, QC, H3N 1X7, Canada
- Department of Social and Preventive Medicine, Sainte-Justine Hospital Research Center, Université de Montréal, 3175 Côte Sainte-Catherine, Room A-830, Montreal, H3T 1C5, QC, Canada
| | - Nadège Zanré
- Department of Obstetrics and Gynecology, Research Centre of University of Montreal Hospital Centre (CRCHUM) and University of Montreal, Tour Saint-Antoine, 850, rue St-Denis, Montreal, QC, H2X 0A9, Canada
| | - Marie-Hélène Mayrand
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Pavilion 7101, Avenue du Parc, Montreal, QC, H3N 1X7, Canada
- Department of Obstetrics and Gynecology, Research Centre of University of Montreal Hospital Centre (CRCHUM) and University of Montreal, Tour Saint-Antoine, 850, rue St-Denis, Montreal, QC, H2X 0A9, Canada
| | - Helen Trottier
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Pavilion 7101, Avenue du Parc, Montreal, QC, H3N 1X7, Canada.
- Department of Social and Preventive Medicine, Sainte-Justine Hospital Research Center, Université de Montréal, 3175 Côte Sainte-Catherine, Room A-830, Montreal, H3T 1C5, QC, Canada.
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