Fetal outcomes in HIV positive mothers on Antiretroviral Therapy compared to HIV negative mothers at Kawempe National Referral Hospital.

Abstract

Background: The initiation of lifelong ART in all HIV-infected pregnant women has the potential to make perinatal HIV infection a rare event, as well as to improve maternal health and survival. However, it will also lead to a rapid rise in the number of fetal antiretroviral (ARV) drug exposures as pregnant and lactating women started on ART have subsequent pregnancies. Objectives: The main study objective was to determine the fetal outcomes of HIV positive participants on ART compared to HIV negative participants at Kawempe National Referral Hospital. The specific objectives were to determine the different fetal outcomes in HIV positive participants on ART compared to HIV negative participants at Kawempe National Referral Hospital and to describe the factors that influenced fetal outcomes in HIV positive participants on ART compared to HIV negative participants at Kawempe National Referral Hospital.Methods: This was a facility-based cross sectional comparative study which was conducted in Kawempe National Referral Hospital, Department of Obstetrics and Gynecology and also a teaching hospital for Makerere University College of Health Sciences. The study population compared the fetal outcomes of participants who were HIV positive on ART, to those in participants who were HIV negative who had delivered at Kawempe National Referral Hospital. A total of 188 participants were enrolled by consecutive sampling for HIV positive and systematic sampling for HIV negative participants, and an equal number of both groups were sampled (n=94) respectively after consenting to participate. A structured interviewer administered questionnaire was used to collect data. Data was collected by the principal investigator and one research assistant upon discharge. Data cleaning and entry was done. It was summarized using descriptive statistics and presented using frequencies and percentages. Comparisons between the various fetal outcomes was done using the Pearson Chi-square test. Factors that influenced fetal outcomes were analyzed using Log-binomial regression analysis model. Analysis was conducted at both crude and adjusted analysis. Results. There were two outcomes which were significantly associated with the HIV status of the participants. These included Low birth weight and preterm birth. The proportion of low birth weight among the HIV positive participants was 25.5% while among the HIV negative participants was 11.7% (Chi-2=4.861, P=0.014). The proportion of preterm birth was 24.5% among HIV positive participants and 9.6% among HIV negative participants (Chi-2=7.305, P=0.026). There were variations in the prevalence of low birth weight and preterm birth by age group, drainage of liquor and vaginal delivery. The prevalence of low birth weight was 2.1 times higher among babies born to HIV positive participants aged 26-30 years [APR=2.1, 95% CI: 1.5-3.7, P=0.016]; low birth weight was 2.3 times higher among babies born to HIV positive participants who had drainage of liquor before onset of labor [APR=2.3, 95% CI: 1.5-5.9, P=0.001] and 2.4 times higher among babies born to HIV positive participants vaginally [APR=2.4, 95% CI: 1.6-6.3, P=0.002]. Preterm birth was 3.3 times higher among babies born by HIV positive participants aged 31-35 years [APR=3.3, 95% CI: 2.1-7.2, P=0.001]. The prevalence of preterm birth was also 3 times higher among babies born to HIV positive participants who had a history of miscarriage [APR=3.0, 95% CI: 2.2-5.9, P=0.012] Conclusion.The findings of this study indicated that despite optimization of maternal health in HIV positive participants through ART, fetal outcomes among HIV-positive women remained worse than those among HIV Negative women. Recommendations. The program for prevention of Mother to child transmission of HIV (PMTCT) services should maximize the need for an early identification of those participants with predicted complications and close monitoring should be done up to the point of delivery. There is need for continued pharmacovigilance of pregnant women receiving different ART regimens for adverse fetal outcomes. It is therefore important to clearly understand the relationship between ART and adverse pregnancy outcomes among pregnant HIV positive women by examining the potential mechanisms by which ART may affect birth outcomes as well as investigation of the safest antiretroviral regimens for use during pregnancy to improve outcomes among HIV-positive mothers and their babies, in the setting of current WHO guidelines for PMTCT and as new antiretroviral drugs enter widespread use.