Pregnancy-Related Outcomes and Mortality in the Years Following Pregnancy among Women Perinatally Infected with HIV — New York City, 2005–2011
Survival among individuals with perinatally-acquired HIV has improved in the United States due to the availability of effective antiretroviral therapy (ART). In New York City (NYC), an epicenter for the early HIV epidemic, there is an aging cohort of perinatally infected individuals who have reached their reproductive years. The aim of our study was to describe pregnancy outcomes and mortality in the years immediately following pregnancy among perinatally infected women who delivered in NYC during 2005–2011.
We utilized data from the NYC HIV Surveillance Registry and the Enhanced Perinatal Surveillance system, an active surveillance system targeting 16 hospitals which account for approximately two-thirds of deliveries among HIV positive mothers in NYC. We compared pregnancy and subsequent mortality outcomes among U.S.-born perinatally infected mothers to U.S.-born heterosexually infected mothers and conducted survival analyses.
During 2005–2011, there were a total of 123 deliveries among 95 U.S.-born perinatally-infected mothers and 612 deliveries among 503 U.S.-born heterosexually infected mothers. Perinatal mothers were younger at the time of delivery (median: 21 vs. 29 years), more likely to be aware of their HIV status and to use ART during their pregnancy but less likely to use substances during their pregnancy. At the time of delivery, perinatal mothers were more likely to have viral loads >1000 copies/ml (35.8% vs. 20.1%) and severe immunosuppression (15.4% vs. 6.7%), and to deliver by elective C-sections (66.7% vs. 51.5%). There were no differences in receipt of prenatal care, use of intrapartum and neonatal ART, mother-to-child transmission (MTCT) rate (1.6% vs. 1.3%), gestational age and birth weight of the delivered infants, and infant mortality. Perinatal mothers, while no more likely to die in the year following delivery, were more likely to die in the ensuing four years (Figure 1) (p=0.0029).
Conclusion: There were no differences between perinatally- and heterosexually-infected mothers in pregnancy-related outcomes and maternal death. However, perinatally-infected mothers were more likely to die during the next four years, likely related to their more advanced HIV disease.
S. Braunstein, None
C. Shepard, None
D. Nash, None
M. Vogler, None
R. M. Gulick, None
V. Peters, None