Increased risk of low birth weight and adverse pregnancy outcomes among women living with HIV

1. In this cohort of women living with HIV (WLWH) in Rwanda, there was an increased risk of delivering a low birth weight (LBW) baby compared to women unaffected by HIV. 

2. Among the WLWH, starting antiretroviral therapy (ART) before pregnancy was associated with a decreased risk of LBW.

Evidence Rating Level: 2 (Good) 

In 2010, the World Health Organization (WHO) recommended triple antiretroviral therapy (ART) for pregnant women living with HIV during pregnancy and breastfeeding. By 2013, these options expanded to lifelong ART regardless of CD4 counts. By 2015, most women receiving ART for prevention of mother-to-child transmission (PMTCT) were on lifelong therapy, resulting in decreased HIV transmission to infants. However, millions of HIV-uninfected infants are now exposed to ART during pregnancy and breastfeeding, with limited knowledge on the long-term effects. With the near-universal ART coverage and growing population of children who are HIV-exposed and uninfected (CHEU), updated evidence on pregnancy outcomes such as low birth weight (LBW) is crucial. This retrospective cohort study addressed the gap by examining adverse birth outcomes among women living with HIV and HIV-uninfected women in Rwanda. The main endpoint was low birth weight, defined as less than 2,500 g, while the secondary endpoints included stillbirth and preterm birth. Of 10,191 eligible women with HIV, 12.7% (n=1,293) were women living with HIV (WLWH). Compared to women without HIV, WLWH had higher rates of LBW babies (2.9% vs 6.5%, p<0.001) and stillbirths (0.4% vs 0.6%, p=0.02), whereas the prevalence of preterm birth was similar (0.5% vs 0.7%, p=0.9). Even after accounting for other factors such as marital status, maternal weight at delivery, and gravida status, HIV positive status was associated with LBW (aOR 1.61; 95% CI, 1.08, 2.39; p<0.05). In WLWH who started ART before pregnancy, there was a 50% decreased odds of delivering a LBW baby compared to WLWH who started ART during pregnancy (OR 0.9; 95% CI 0.52, 1.56). Overall, these results indicate the importance of receiving early HIV diagnosis and treatment, particularly in the prenatal phase. 

Click to read the study in PLOSONE

Image: PD

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