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The effect of HIV-centered obstetric care on perinatal outcomes among a cohort of women living with HIV.

The effect of HIV-centered obstetric care on perinatal outcomes among a cohort of women living with HIV.
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Powell AM, DeVita JM, Ogburu-Ogbonnaya A, Peterson A, Lazenby GB,


Powell AM, DeVita JM, Ogburu-Ogbonnaya A, Peterson A, Lazenby GB, (click to view)

Powell AM, DeVita JM, Ogburu-Ogbonnaya A, Peterson A, Lazenby GB,

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Journal of acquired immune deficiency syndromes (1999) 2017 04 26() doi 10.1097/QAI.0000000000001432

Abstract
BACKGROUND
Elimination of perinatal transmission is possible but limited by missed care opportunities. Our objective was to investigate the effects of HIV-centered obstetric care (HCC) on missed care opportunities and perinatal HIV transmission in two obstetric cohorts at our institution from 2000-2014.

METHODS
This was a retrospective cohort study of HIV-exposed mother-infant pairs delivering from 2000-2014, analyzed according to SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guidelines. Before 2009, women received care in high risk pregnancy clinics (HRC); subsequently a HCC service was established. Women who received HRC versus HCC obstetric care were compared to determine differences in maternal and neonatal outcomes. Continuous variables were compared with Student’s t-test and Wilcoxon Rank Sum Tests. Categorical variables were compared using χfn2 test and Fisher’s exact test. Logistic regression analyses were performed to determine factors associated with outcomes of interest.

RESULTS
Over 14 years, 161 women delivered 217 HIV-exposed infants; 78 (36%) women received HCC. Two perinatal HIV transmissions (1.5%) occurred in HRC group compared with none in the HCC group (p=0.3). Women in HCC were more likely to have HIV RNA viral load < 1,000 copies/mL at delivery (12% vs 26%, p=0.02), have a contraception plan prior to delivery (93% vs 60%, p<0.001), return for postpartum evaluation (80% vs 63%, p=0.01), and have undetectable HIV viral load postpartum (50 copies/mL vs 2067, p < 0.0001). CONCLUSION
HCC can potentially reduce the risk of perinatal HIV transmission by improving maternal virologic control during pregnancy and postpartum and increasing postpartum contraceptive use.

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