Management and outcomes of pregnancies among women with HIV in Oxford, UK, in 2008-2012
Montgomery-Taylor S., Hemelaar J.
© 2015 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics.Objective To evaluate the management and outcomes of pregnancies among women with HIV infection. Methods A retrospective cohort study was undertaken of pregnant women with HIV who delivered at one center in the UK in 2008-2012. Case notes were reviewed and detailed information extracted regarding obstetric and virological management. Results Overall, 61 pregnancies were included; 43% (26/60) were unplanned and 39% (22/57) booked late. HIV infection was diagnosed during pregnancy for 32% (19/60); 71% (12/17) were diagnosed after the first trimester. At booking, 47% of women (28/60) were not on treatment, all but one of whom commenced treatment, either for maternal reasons (CD4 count < 350 cells per mm3; 48% [13/27]) or prevention of mother-to-child-transmission (52% [14/27]). Viral load was high (> 50 copies per mL) at delivery for 13% of women (8/61). Delivery was by cesarean for 74% [45/61]. One neonate was diagnosed with HIV infection. There were 6 (10%) preterm births, 9 (15%) cases of low birth weight, 11 (18%) small-for-gestational-age neonates, and 1 (2%) stillbirth. Conclusion Better pregnancy planning, earlier booking and HIV diagnosis, and optimal antiretroviral treatment should increase the proportion of women with a low viral load (< 50 copies per mL) at delivery, lead to more vaginal deliveries, and further reduce mother-to-child transmission of HIV.