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      Association between maternal HIV infection and low birth weight and prematurity: a meta-analysis of cohort studies

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          Abstract

          Background

          To assess the association between maternal human immunodeficiency virus (HIV) infection and low birth weight (LBW)/prematurity (PTD), we conducted a meta-analysis of cohort studies of HIV infected and uninfected women.

          Methods

          Several English and Chinese databases were searched (updated to May 2015) to find the studies reporting infant outcomes associated with exposure to maternal HIV infection during pregnancy. Relevant articles were manually selected based on several inclusion and exclusion criteria.

          Results

          Fifty-two cohort studies including 15,538 (for LBW) and 200,896 (for PTD) HIV infected women met the inclusion criteria. There was significant heterogeneity among studies for maternal HIV infection associated with LBW/PTD (I 2 = 71.7 %, P < 0.05, and I 2 = 51.8 %, P < 0.05 for LBW and PTD, respectively). The meta-analysis demonstrated that the maternal HIV infection was significantly associated with both LBW (pooled odds ratio (OR): 1.73, 95 % confidence interval (CI): 1.64, 1.82, P < 0.001) and PTD (pooled OR: 1.56, 95 % CI: 1.49, 1.63, P < 0.001). No significant difference in the relationship between maternal HIV infection and adverse pregnancy outcomes was detected among the groups of different study periods. HIV infected women were at slightly higher risk of LBW in developing countries compared with women in developed countries (OR: 2.12 (95 % CI: 1.81, 2.48) vs. 1.75 (95 % CI: 1.44, 2.12)). Antiretroviral drugs usage did not significantly change the associations of maternal HIV exposure with LBW and PTD.

          Conclusions

          HIV infected women were at higher risk of having a low birth weight infant or a preterm delivery infant compared with uninfected women. Such associations did not change significantly over time or were not significantly affected by the usage of antiretroviral drugs.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12884-015-0684-z) contains supplementary material, which is available to authorized users.

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          Most cited references58

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          Use of antiretroviral therapy in pregnant HIV-infected women and the risk of premature delivery: a meta-analysis.

          Joseph Lau, Athena Kourtis, Christopher H Schmid … (2007)
          The use of antiretroviral agents in pregnant HIV-infected women has been reported to increase the risk of premature delivery in some studies. We performed a meta-analysis on relevant studies to address this question. We searched Medline, Embase and the Cochrane Controlled Clinical Trials Register for English language articles. Studies that reported premature delivery for HIV-infected women treated with antiretroviral regimens during pregnancy were selected. Meta-analyses were performed using a random effects model. Thirteen prospective cohorts and one retrospective study met the inclusion criteria. Antiretroviral therapy during pregnancy did not increase the risk of premature delivery overall [odds ratio (OR) 1.01, 95% confidence interval (CI) 0.76-1.34]. In subgroup analyses, compared with no therapy, monotherapy (mostly zidovudine) conferred an OR of 0.86 (95% CI 0.73-1.01), whereas combination therapy conferred an OR of 1.13 (95% CI 0.79-1.63). The use of protease inhibitor (PI)-containing combinations resulted in an OR for premature delivery of 1.24 (95% CI 0.76-2.02), compared with combinations without PI. The initiation of combination therapy before pregnancy or in the first trimester resulted in an OR of 1.71 (95% CI 1.09-2.67) compared with therapy initiation in the second trimester and beyond. There was a large degree of heterogeneity between studies. Evidence indicates that antiretroviral therapy during pregnancy is not associated with an overall increased risk of premature delivery. The use of combination regimens before or early in pregnancy may slightly increase the risk of prematurity. Continued surveillance will be necessary to quantify such a risk accurately.
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            The association between maternal HIV infection and perinatal outcome: a systematic review of the literature and meta-analysis

            Peter Brocklehurst, Rebecca French (1998)
            Article 0 comments Cited 54 times – based on 0 reviews     Review now
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              The association between maternal HIV infection and perinatal outcome: a systematic review of the literature and meta-analysis.

              Ruth R. French, P Brocklehurst (1998)
              To investigate the association between maternal HIV infection and perinatal outcome by a systematic review of the literature and meta-analysis. Appropriate publications were identified using electronic and hand searching of relevant journals from 1983 to 1996. Studies were included in the review if they were prospective cohorts with pregnant women identified as being HIV-infected with a control group of pregnant women who were not infected with HIV. Methodological quality was assessed for each study. Data were extracted for pre-determined outcome measures. Sensitivity analyses were performed to explore the association between HIV infection and an adverse perinatal outcome for the following study characteristics: clinical setting (developed or developing countries), methodological quality (high or poor) and whether studies controlled for potential confounding. Thirty-one studies were eligible to be included in the review. The summary odds ratio of the risk of pre-defined adverse perinatal outcomes related to maternal HIV infection were as follows: spontaneous abortion 4.05 (95% CI 2.75-5.96); stillbirth 3.91 (95% CI 2.65-5.77); fetal abnormality 1.08 (95% CI 0.7-1.66); perinatal mortality 1.79 (95% CI 1.14-2.81); neonatal mortality 1.10 (95% CI 0.63-1.93); infant mortality 3.69 (95% CI 3.03-4.49); intrauterine growth retardation 1.7 (95% CI 1.43-2.02); low birthweight 2.09 (95% CI 1.86-2.35) and pre-term delivery 1 83 (95% CI 1.63-2.06). Sensitivity analyses showed that the association between infant mortality and maternal HIV infection was stronger in studies conducted in developing countries when compared with developed countries [odds ratios (OR) 3.72 (95% CI 3.05-4.54) and 8.6 (95% CI 0.53-141.05), respectively]; studies of higher methodological quality compared with those of poorer quality [odds ratios 14.57 (95% CI 6.93-30.65) and 3.37 (95% CI 2.74-4.14), respectively] and studies which had used restriction or matching to control for potential confounding factors compared with those that had not [OR 11.60 (95% CI 5.71-23.58) and 3.35 (95% CI 2.73-4.12), respectively]. The findings of this review have implications for women infected with HIV who are planning a pregnancy or who find themselves pregnant. There appears to be an association, although not strong, between maternal HIV infection and an adverse perinatal outcome. This relationship may be due to bias including uncontrolled or residual confounding. There does, however, appear to be a real and large increase in the risk of infant death in developing countries associated with maternal HIV infection, especially so when there has been an attempt to control for confounding.
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                Author and article information

                Contributors
                Peng-Lei Xiao: xiaopl90@163.com
                Yi-Biao Zhou: 021-54237974 , ybzhou@fudan.edu.cn
                Yue Chen: yue.chen@uottawa.ca
                Mei-Xia Yang: 1057339623@qq.com
                Xiu-Xia Song: xxsong@fudan.edu.cn
                Yan Shi: 13211020008@fudan.edu.cn
                Qing-Wu Jiang: jiangqw@fudan.edu.cn
                Journal
                Journal ID (nlm-ta): BMC Pregnancy Childbirth
                Journal ID (iso-abbrev): BMC Pregnancy Childbirth
                Title: BMC Pregnancy and Childbirth
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2393
                Publication date (Electronic): 8 October 2015
                Publication date PMC-release: 8 October 2015
                Publication date Collection: 2015
                Volume: 15
                Electronic Location Identifier: 246
                Affiliations
                [ ]Fudan University School of Public Health, Building 8, 130 Dong’an Road, Xuhui District, Shanghai, 200032 China
                [ ]Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong’an Road, Xuhui District, Shanghai, 200032 China
                [ ]Fudan University Center for Tropical Disease Research, Building 8, 130 Dong’an Road, Xuhui District, Shanghai, 200032 China
                [ ]School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8 M5 Canada
                [ ]Xuhui Center for Disease Prevention and Control, 50 Yongchuan Road, Xuhui District, Shanghai, 200032 China
                Article
                Publisher ID: 684
                DOI: 10.1186/s12884-015-0684-z
                PMC ID: 4599647
                PubMed ID: 26450602
                SO-VID: 0a72a70e-22e2-4bf2-bb91-7225a595fe1f
                Copyright © © Xiao et al. 2015
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 14 June 2015
                Date accepted : 4 October 2015
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2015

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: maternal hiv infection,meta-analysis,low birth weight,preterm delivery
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: maternal hiv infection, meta-analysis, low birth weight, preterm delivery

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