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Trop Med Int Health. 2019 Mar 19. doi: 10.1111/tmi.13233. [Epub ahead of print]

Timing of combination antiretroviral therapy (cART) initiation is not associated with stillbirth among HIV-infected pregnant women in Malawi.

Author information

1
Institute of Global Health, University of Geneva, Geneva, Switzerland.
2
Baobab Health Trust, Lilongwe, Malawi.
3
Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi.
4
Dignitas International, Zomba, Malawi.
5
Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
6
The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
7
Centre of Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
8
Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland.

Abstract

OBJECTIVE:

To assess the association between timing of maternal combination ART (cART) initiation and stillbirth among HIV-infected pregnant women in Malawi's Option B+ programme.

METHODS:

Cohort study of HIV-infected pregnant women delivering singleton live or stillborn babies at ≥28 weeks of gestation using routine data from maternity registers between 1 January 2012 and 30 June 2015. We defined stillbirth as death of a foetus at ≥28 weeks of gestation. We report proportions of stillbirth according to timing of maternal cART initiation (before pregnancy, 1st or 2nd trimester, or 3rd trimester or labour). We used logistic regression, with robust standard errors to account for clustering of women within health facilities, to investigate the association between timing of cART initiation and stillbirth.

RESULTS:

Of 10 558 mother-infant pairs abstracted from registers, 8380 (79.4%) met inclusion criteria. The overall rate of stillbirth was 25 per 1000 deliveries (95% confidence interval 22-29). We found no significant association between timing of maternal cART initiation and stillbirth. In multivariable models, older maternal age, male sex of the infant, breech vaginal delivery, delivery at < 34 weeks of gestation and experience of any maternal obstetric complication were associated with higher odds of stillbirth. Deliveries managed by a mission hospital or health centre were associated with lower odds of stillbirth.

CONCLUSION:

Pregnant women's exposure to cART, regardless of time of its initiation, was not associated with increased odds of stillbirth.

KEYWORDS:

HIV ; Malawi; Option B+; combination antiretroviral therapy; stillbirth

PMID:
30891866
DOI:
10.1111/tmi.13233

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