Late pregnancy loss in HIV-positive women
Polly Clayden, HIV i-Base
Data were presented from a retrospective case note review of HIV-positive women receiving antenatal care at Homerton Hospital, East London between 2000 and 2007, whose pregnancies resulted in either late miscarriage or interuterine death.
The investigators reported 242 pregnancies during the study period, of these19/242 (8%) in 18 women resulted in late pregnancy loss. 15 of these were late miscarriages (defined as loss at 14-24 weeks gestation) and 4 intrauterine deaths (beyond 24 weeks gestation).
The mean maternal age was 31.6 years (range 23.3-39.4 years). 14/18 (78%) women were originally from sub-Saharan Africa and 11/18 (61%) were of uncertain immigration status.
Significant psychosocial problems were reported in 7/18 (39%) of the women.
10/18 (56%) of women received their HIV diagnosis during this pregnancy. 14/18 (76%) were CDC Stage A; their mean nadir CD4 was 327 cells/mm3 (393 cells/mm3 at pregnancy loss). 38% of women had viral load <400 copies/mL and 56% between 400 and 100,000 copies/mL). 8/18 (42%) of women were receiving HAART during their pregnancy. The median gestational age at loss was 18 weeks (range 14 to 39 weeks).
14/19 postmortems were performed. 10/14 post-mortems showed chorioamnionitis; Group B Streptococcus was identified in one. One post-mortem showed toxoplasma placentitis.
The investigators noted that all women in the study group attended for HIV follow-up following their pregnancy loss. They concluded: “We advocate further large-scale research to elucidate the mechanisms underlying late pregnancy loss in HIV?”.
The investigators described the rate of late loss in pregnancy as high (8%) compared to background general population rate of 2% (4% in east London).
Although they were unable to confirm cause of this rate of late loss, they highlight the need for sexual health screening during pregnancy, which in this cohort only occurred in 53% of women undergoing review.
J Anderson, R Evans-Jones, D Janga, et al. Pregnancy loss in HIV-positive women attending antenatal care at a London centre. 14th Annual BHIVA Conference, Dublin, 2008. HIV Medicine, 9 (Suppl. 1). O14