{"id":32296,"date":"2017-08-10T12:13:00","date_gmt":"2017-08-10T12:13:00","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=32296"},"modified":"2017-08-15T08:26:50","modified_gmt":"2017-08-15T08:26:50","slug":"stillbirth-rate-in-hiv-positive-women-in-ukireland-is-double-that-of-the-general-population","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/32296","title":{"rendered":"Stillbirth rate in HIV positive women in UK\/Ireland is double that of the general population"},"content":{"rendered":"

\"IASPolly Clayden, HIV i-Base<\/strong><\/p>\n

Stillbirth rate in HIV positive women in UK\/Ireland was around twice that reported in the general population in 2007\u20132015, despite declines in vertical transmission and increases in women conceiving on ART and delivering with undetectable viral load.<\/strong><\/p>\n

These findings from the UK and Ireland National Study on HIV and Pregnancy and Childhood (NSHPC) were presented at IAS 2017.<\/p>\n

The study authors noted that stillbirth has multifactorial and incompletely understood causes. They previously reported higher rates than in the general population between 1990\u20132006: 1.1% vs 0.5%. This period saw big changes in maternal HIV treatment and vertical transmission interventions.<\/p>\n

The more recent analysis was conducted to explore the current stillbirth rate and risk factors in HIV positive women delivering in UK\/Ireland between 2007\u20132015 (reported to NSHPC by December 2016).<\/p>\n

Stillbirth was defined as a baby delivered at 24 gestational weeks or more showing no signs of life.<\/p>\n

During the study period, there were 10,316 pregnancies in 8069 mothers: 75.4% of mothers were born in sub-Saharan Africa; 49.4% conceived on ART; 55% received a PI-based regimen and 24.5% NNRTI-based; there were 43 (0.4%) vertical transmissions; and 89 (0.9%) stillbirths.<\/p>\n

There was no decline in rate of stillbirth reported to the NSHPC over this period, p=0.24. The Office for National Statistics for England and Wales reported a stillbirth rate of 0.5% during the same period of time.<\/p>\n

Compared with live births, stillbirths were more likely to be male (58.21 vs 41.79%), delivered pre-term (median 33 vs 39 gestational weeks), small for gestational age (54.84 vs 21.12%) and have congenital abnormalities (14.75 vs 2.85%). But data on gender, small for gestational age and congenital abnormalities were missing for approximately 25, 30 and 31% of still births respectively.<\/p>\n

In multivariate analysis, significant risk factors associated with stillbirth were: antenatal CD4 count <<\/span>350cells\/mm3<\/sup> and mother being primiparous, older and originating from sub-Saharan Africa or other non-western European countries. Delivery year, ART at conception and antenatal ART class attendance were not significantly associated with stillbirth. See table 1.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Table 1: Adjusted risk factors associated with stillbirth<\/caption>\n
Risk factor<\/th>\nIRR (95% CI)<\/th>\n<\/tr>\n
Maternal age(years)<\/td>\n<28<\/td>\n1.00<\/td>\n<\/tr>\n
28\u201332<\/td>\n3.38 (1.25 to 9.16)<\/td>\n<\/tr>\n
33\u201336<\/td>\n3.57 (1.25 to 9.66)<\/td>\n<\/tr>\n
>36<\/td>\n4.12 (1.49 to 11.35)<\/td>\n<\/tr>\n
Parity<\/td>\nPrimiparous<\/td>\n1.85 (1.10 to 3.12)<\/td>\n<\/tr>\n
Multiparous<\/td>\n1.00<\/td>\n<\/tr>\n
Maternal origin<\/td>\nEurope\/WEWC<\/td>\n1.00<\/td>\n<\/tr>\n
SSA<\/td>\n3.26 (1.07 to 9.95)<\/td>\n<\/tr>\n
Other<\/td>\n5.59 (1.49 to 21.48)<\/td>\n<\/tr>\n
Maternal CD4 count<\/td>\n>350<\/td>\n1.00<\/td>\n<\/tr>\n
<<\/span>350<\/td>\n1.73 (1.05 to 2.86)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Key: IRR, incident rate ratio; SSA, sub-Saharan Africa; WEWC, westernised countries.<\/p>\n

The authors pointed out the limitations to this study: NSHPC does not record data on other important risk factors for stillbirth eg maternal BMI, socio-economic status and smoking and there were limited data to classify stillbirth as antepartum or intrapartum. They also noted that details of stillbirths were under reported.<\/p>\n

Reference:<\/p>\n

Favarato G et al. Stillbirth in HIV-infected women delivering in UK\/Ireland between 2007 and 2015. IAS 2017. 23\u201326 July 2017. Paris. Poster abstract MOPDC0104.
\nhttp:\/\/programme.ias2017.org\/Abstract\/Abstract\/4703<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Polly Clayden, HIV i-Base Stillbirth rate in HIV positive women in UK\/Ireland was around twice that reported in the general population in 2007\u20132015, despite declines in vertical transmission and increases in women conceiving on ART and delivering with undetectable viral …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,35],"tags":[243],"class_list":["post-32296","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-pmtct-and-maternal-health","tag-ias-9-paris-2017"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/32296","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=32296"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/32296\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=32296"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=32296"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=32296"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}