Background
People living with HIV (PLWH) receiving contemporary treatment may have increased risk for low birth weight (LBW) or preterm birth (PTB). We hypothesized that LBW and PTB rates among PLWH in an HIV Pregnancy cohort (HP) would not differ from Washington State (WA) birth registry data. We also evaluated perinatal HIV-1 transmission among births to PLWH in WA, comparing those who participated in HP with those who did not.
Methods
This observational retrospective cohort study compared LBW and PTB rates for 292 HP and 1,173,408 WA live births, 2009-2022. The proportion of all PLWH births in WA that received care with HP was calculated from WA HIV surveillance data. HP participants received prenatal and HIV care and delivered at the University of Washington Medical Center (UW). HP birth outcomes were abstracted from the UW HP Cohort Registry, while WA outcomes were obtained from public birth registry data, subtracting HP births to avoid counting them twice. Rates of LBW(<2500g) and PTB(<37 weeks) among singleton HP and WA were assessed in 2-year blocks. Perinatal HIV-1 transmission among all live births for PLWH in HP was compared to WA HIV surveillance data for births to PLWH not in HP. Odds ratios (OR), 95% confidence intervals (CI), chi-square (Χ2) and Fisher’s exact test were used to assess statistical significance.
Results
Of 519 live births to WA PLWH, 292 (56.26%) were included in HP (284 singletons, 8 twins). Among singletons, LBW occurred more frequently among HP (35/284 (12.32%)) compared to WA (59,228/1,173,408 (5.05%); OR 2.64, 95% CI 1.86-3.76). PTB rates did not differ significantly between HP (9.15%) and WA (8.53%; OR 1.08, 95% CI 0.72-1.62). WA rates increased over time for LBW and PTB (Χ2 test for trend P<0.001 for both). HP LBW and PTB time trends were not evaluable due to small sample size. Among all live births including twins, there were 0/292 HIV-1 transmissions among HP (0%, 95% CI 0-1.03%) and 6/244 among PLWH not in HP (2.46%, 95% CI 1.21-3.71%; Fisher’s exact 2-tail P =0.0086). Birth parent HIV diagnosis occurred before or during pregnancy for 5 of 6 affected infants; 4 infants were diagnosed with HIV at ≤ 1 month of age, and 2 diagnosed at > 1 year of age with probable breastfeeding transmission.
Conclusions
PLWH receiving prenatal and HIV care in a contemporary HP program had an increased risk of LBW but not PTB compared to WA birth registry data. Perinatal HIV-1 transmission occurred only among PLWH not in HP, suggesting missed prevention opportunities.
Table or Figure
