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Risk of intrauterine growth restriction among HIV-infected pregnant women: a cohort study

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Abstract

The purpose of this investigation was to study the risk of intrauterine growth restriction in human immunodeficiency virus (HIV)-infected women and to describe the associated risk factors. A cohort study was performed among HIV-infected women who delivered in a single tertiary centre in Barcelona, Spain, from January 2006 to December 2011. Consecutive singleton pregnancies delivered beyond 22 weeks of pregnancy were included. Intrauterine growth restriction (IUGR) was defined as a birth weight below the 10th customised centile for gestational age and IUGR babies were compared to non-IUGR newborns. Intrauterine Doppler findings were described among IUGR foetuses. Baseline characteristics, HIV infection data and perinatal outcome were compared between groups. The results were adjusted for potential confounders. A total of 156 singleton pregnancies were included. IUGR occurred in 23.4 % of cases (38/156). In two-thirds of the cases detected before birth, Doppler abnormalities compatible with placental insufficiency were observed. IUGR pregnancies presented a worse perinatal outcome, mainly due to a higher risk of iatrogenic preterm delivery [adjusted odds ratio 6.9, 95 % confidence interval (CI) 1.4–33.5]. IUGR foetuses also had a higher risk of emergent Caesarean section and neonatal intensive care unit admission. No cases of intrauterine foetal death occurred. A high rate of IUGR was observed among HIV pregnancies, and it was associated with adverse perinatal outcomes, mainly iatrogenic preterm and very preterm birth due to placental insufficiency. Our results support that ultrasound detection and follow-up of IUGR foetuses should be part of routine antenatal care in this high-risk population to improve antenatal management.

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Acknowledgements

M.L., F.F., M.P. and J.O.C. contributed to the conception and design of the study. They also performed the analysis, statistics and interpretation of the results. M.L., A.G., S.H., M.Lonca and J.O.C. performed the patient follow-up and collected the clinical information of the study participants. M.L., S.H., L.G. and F.J.B. worked on database updating. All authors underwent a critical revision of the manuscript and gave their final approval of the version to be published.

Ethical standards

All participants gave written informed consent for ultrasound foetal assessment according to the local Ethics Committee and in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The analysis of data was performed anonymously from medical records collected for clinical management, with omission of details that might disclose the identity of the subjects under study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), C/Sabino de Arana, 1, 08028, Barcelona, Spain

    M. López, M. Palacio, A. Goncé, S. Hernàndez, F. J. Barranco, L. García, J. O. Coll, E. Gratacós & F. Figueras

  2. Infectious Diseases Department, Hospital Clinic, University of Barcelona, C/Villarroel, 170, 08036, Barcelona, Spain

    M. Loncà

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  1. M. López
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  2. M. Palacio
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  3. A. Goncé
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  4. S. Hernàndez
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  5. F. J. Barranco
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  6. L. García
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  7. M. Loncà
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  8. J. O. Coll
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  9. E. Gratacós
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  10. F. Figueras
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Correspondence to M. López.

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López, M., Palacio, M., Goncé, A. et al. Risk of intrauterine growth restriction among HIV-infected pregnant women: a cohort study. Eur J Clin Microbiol Infect Dis 34, 223–230 (2015). https://doi.org/10.1007/s10096-014-2224-6

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  • DOI: https://doi.org/10.1007/s10096-014-2224-6

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