PREGNANCY OUTCOMES IN MOTHERS WITH ADVANCED HUMAN IMMUNODEFICIENCY VIRUS DISEASE

Abstract

Objective: To determine the impact of HIV disease on immediate maternal and foetaloutcomes at the Kenyatta National Hospital, Nairobi, Kenya

Design: Prospective cohort study.

Setting: Kenyatta National Hospital, Nairobi, Kenya, between September 2004 andApril 2005.

Subjects: Sixty eight mothers with advanced HIV disease (WHO clinical stage 3 and4) and 68 HIV negative pregnant mothers.

Results: Mothers with advanced HIV disease were more likely to be anaemic (55% vs.16% p<0.001), to have sexually transmitted diseases (56% vs. 15%, p=0.004), to havechorioamnionitis (14.8% vs. 2%, p=0.004), to develop preterm premature rupture ofmembranes (31 % vs. 9%, p<0.001), to have puerperal pyrexia (16% vs. 2%, p=0.032)an to die (5% vs. 0.5%, p=0.028) compared to HIV negative mothers. The meangestational age at deliver was lower in mothers with advanced HIV disease comparedto the seronegative counterparts (73% vs. 32%, delivery<37 weeks, p<0.00l). Infants ofmothers with advanced HIV disease compared to infants of seronegative mothers weremore likely to be low birth weight infants (58% vs. 21%, p<0.00l), stillborn (4% vs.2%, p=0.308) and to have low Apgar scores (28% vs. 12%, Apgar score < 4 at 5 minutesp=0.02). Perinatal sepsis and perinatal deaths were more common in infants born tomothers with advanced HIV disease compared to infants born to HIV negative mothers(8 vs. 3, p=0.003 and 14 vs. 5, p=0.025 respectively). External congenital anomalies weresimilar in the two groups (5.9% vs. 5.9%).

Conclusion: Pregnancies complicated by advanced HIV disease are more likely to haveadverse outcomes, both maternal and foetal. Advanced HIV disease is associated withincreased risk of both maternal and fetal mortality. HIV infected mothers should becounselled on the increased pregnancy risks associated with advanced disease.