476. Pregnancy among Perinatally HIV-infected (PHI) Women is Associated with Increased Risk of Adverse Outcome in Bronx, NY, 2002-20011
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1
Background:   Increasing numbers of PHI women are surviving to reproductive age.  By 2011, reports of 64 live births to these women have been published.  Overall, outcomes have been similar to those among women infected later in life.

Methods: We performed a retrospective analysis of pregnancy outcomes among HIV-infected women aged 27 years or less who presented for pregnancy care, 2002-2011.  Cases were classified according to route of maternal infection: perinatal or sexual, and we examined baseline maternal characteristics, treatment strategies, pregnancy complications and outcomes.  Statistical significance was determined using the Fisher exact probability test and two-tailed t-test for independent samples.

Results: 

One hundred pregnancies among 88 women 27 years old or less were identified: 25(28%) of these women were PHI who had 34 pregnancies (34%).  Age range was the same for both groups (16-27y) as was race/ethnicity and mental health history. PHI women were younger (mean age 21.3y vs 24.0y, P<.01), had higher numbers of pre-existing medical illnesses, and had lower CD4 counts at registration, with 35%<200cells/mm3 vs 4.5% in sexually infected women (P=0.003).  Overall, non-protease inhibitor antiretroviral treatment combinations (noPI) were used in 19 pregnancies:  1 of 34 PHI pregnancies and 18 of 66 pregnancies among sexually infected women (2.9% vs 27.2%, P=0.005).
Outcomes were also different between the two groups: 

Maternal Transmission

Perinatally Infected

Sexually Infected

P-value

       Mean Gest Age (wk)

33.7

38.8

0.014

Mean Birth Weight (g)

2387

3064

0.02

Birth Weight <2500g

31.80%

10.90%

0.03

Birth Weight <1500g

18.10%

5.50%

0.10

Severe Preeclampsia

3

0

 

Cardiomyopathy

2

0

 

Renal Disease

5

0

 

Fetal Death

2

1

 

Neonatal Death

1

0

 

Maternal Death

1

0

 

Conclusion: Unlike most reports to date, we have observed significant differences in pregnancy outcome among PHI women compared to sexually infected women from the same age group.  Percent low birth weight and pregnancy complications were higher and mean birth weight and gestational age at delivery were lower among PHI.  We noted that preexisting medical illness was also associated with adverse pregnancy outcome. 


Subject Category: H. HIV/AIDS and other retroviruses

Karen Beckerman, MD, Albert Einstein College of Medicine, New York, NY, Angela Giovanniello, D Pharm, Family and Community Medicine, Albert Einstein College of Medicine, Bronx, NY and Rodney Wright, MD, MS, Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY

Disclosures:

K. Beckerman, None

A. Giovanniello, None

R. Wright, None

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