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J Reprod Med. 1997 Jul;42(7):429-34.

Impact of pregnancy on maternal AIDS.

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1
Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.

Abstract

OBJECTIVE:

To assess the impact of pregnancy on maternal acquired immunodeficiency syndrome (AIDS) among tribal women in India.

STUDY DESIGN:

From February 1992 to February 1996, 71 tribal women from Manipur, India, with AIDS (Centers for Disease Control stage iii/iv), matched for age, parity, CD4 lymphocyte count and demographic characteristics, were recruited into a prospective study. Thirty-two (49%) of these women were pregnant (8-10 weeks) (group A) and 38 (51%) nonpregnant (group B).

RESULTS:

Pneumocystis carinii pneumonia followed by miliary tuberculosis and wasting disease were the most common AIDS-defining illness and cause of maternal death in both groups. A total of 28 (39%) women died as a direct result of their AIDS-defining illness; 10 (27%) of them were among the nonpregnant women as compared to 18 (56%) deaths among the pregnant women (P = .17, odds ratio 3.7285, 95% confidence interval 1.23, 11.58). Three (16%) of these 18 deaths occurred within 14 weeks of an uneventful first-trimester medical termination of pregnancy. Thirteen women (41%) died undelivered at 30-34 weeks' gestation, and two died within 3 weeks of delivery. Fourteen (44%) women vaginally delivered 14 preterm infants, between 28 and 35 weeks' gestation. Eleven of these infants died within six weeks; nine deaths were a direct result of prematurity and clinical diagnosis of an AIDS-defining illness. The mean survival time was 9.72 months for the pregnant women and 22.6 months for the nonpregnant women (P = .066).

CONCLUSION:

Pregnancy increased maternal and fetal mortality in these AIDS-infected women.

PIP:

The effects of pregnancy on maternal AIDS were investigated in a prospective study (1992-96) of 71 HIV-positive tribal women from Manipur, India. 32 women (49%) were pregnant during the study period. Both pregnant and non-pregnant women were matched in terms of age, parity, CD4 lymphocyte counts, and demographic attributes. The most frequent AIDS-defining illnesses were Pneumocystis carinii pneumonia (PCP), miliary tuberculosis, and wasting syndrome. 3 pregnant women with PCP died after early induced abortion and another 13 died undelivered at 30-36 weeks' gestation; the remaining 14 women vaginally delivered a preterm infant at 28-35 weeks' gestation. As pregnancy progressed, these women's CD4 counts declined in association with their AIDS-related clinical deterioration. 11 of the 14 infants died within 6 weeks of delivery. 2 of the 14 surviving HIV-infected mothers died of fulminating PCP within 3 weeks of delivery. Overall, 18 (56%) of the HIV-infected pregnant women died within 17 months of becoming pregnant as a result of a rapidly progressing AIDS-defining illness, while only 10 (26%) of the non-pregnant women with AIDS died within 42 months of their AIDS diagnosis. The mean survival time was 9.72 months in the former group and 22.6 months in the latter group. These findings indicate that pregnancy in women with AIDS has a significant detrimental effect on both maternal and obstetric outcome and accelerates disease progression. Large prospective, multicenter studies of pregnant HIV-infected women would facilitate better understanding of the variables determining disease progression and clinical outcomes in both mother and child.

PMID:
9252934
[Indexed for MEDLINE]
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