Top

BMC Pregnancy and Childbirth

Published in:

Open Access 01-12-2016 | Research article

Improved pregnancy outcomes with increasing antiretroviral coverage in South Africa

Authors: Theron Moodley, Dhayendre Moodley, Motshedisi Sebitloane, Niren Maharaj, Benn Sartorius

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

Abstract

Background

Universal multi drug antiretroviral treatment in pregnancy is a global priority in our bid to eliminate paediatric HIV infections although few studies have documented the impact of antiretroviral coverage on overall pregnancy outcomes.

Methods

We conducted a maternity audit at a large regional hospital in South Africa during July-December 2011 and January-June 2014 with an aim to determine an association between pregnancy outcomes and the ARV treatment guidelines implemented during those specific periods. During 2011, women received either Zidovudine/sd Nevirapine or Stavudine/Lamivudine/Nevirapine if CD4+ count was < 350 cells/ml. During 2014, all HIV positive pregnant women were eligible for a fixed dose combination (FDC) of triple ARVs (Tenofovir/Emtracitabine/Efavirenz).

Results

In 2011, 622 (35.9 %) of 1732 HIV positive pregnant women received triple antiretrovirals (D4T/3TC/NVP) and in 2014, 2104 (94.8 %) of 2219 HIV positive pregnant women received the fixed dose combination (TDF/FTC/EFV). We observed a reduction in the proportion of unregistered pregnancies, caesarean delivery rate, still birth rate, very low birth weight rate, and very premature delivery rate in 2014. In a bivariate analysis of all 9,847 deliveries, unregistered pregnancies (2.2 %) and HIV infection (37.8 %) remained significant risk factors for SB(OR 6.36 and 1.43 respectively), PTD(OR 4.23 and 1.26 respectively),LBW (OR 4.07 and 1.26 respectively) and SGA(OR 2.17 and 1.151 respectively). In a multivariable analysis of HIV positive women only, having received AZT/NVP or D4T/3TC/NVP or EFV/TDF/FTC as opposed to not receiving any ARV was significantly associated with reduced odds of a SB (OR 0.08, 0.21 and 0.18 respectively), PTD (OR 0.52, 0.68 and 0.56 respectively) and LBW(0.37, 0.61 and 0.52 respectively).

Conclusion

An improvement in birth outcomes is likely associated with the increased coverage of triple antiretroviral treatment for pregnant women. And untreated HIV infected women and women who do not seek antenatal care should be considered most at risk for poor birth outcomes.

World Health Organisation. Antiretroviral drugs for Treating Pregnant Women and Preventing HIV Infection in Infants: Towards Universal Access: Recommendations for a Public Health Apprach. Geneva: WHO Department of HIV/AIDS; 2006.

World Health Organization. Antiretroviral Therapy for HIV Infection in Adults and Adolescents: Recommendations for a Public Health Approach. Geneva, Switzerland: WHO Department of HIV/AIDS; 2010. Revision.

Moodley P, Parboosing R, Moodley D. Reduction in Perinatal HIV infections in KwaZulu-Natal, South Africa in the era of more effective PMTCT Interventions (2004–2012). JAIDS. 2013;63(3):410–5. doi:10.1097/QAI.0b013e3182926931.PubMed

Stringer JSA, Stinson K, Tih PM, Giganti MJ, Ekouevi DK, et al. Measuring coverage in MNCH: population HIV-free survival among children under Two years of Age in four African countries. PLoS Med. 2013;10(5), e1001424. doi:10.1371/journal.pmed.1001424.CrossRefPubMedPubMedCentral

Joint United Nations Programme on HIV/AIDS (UNAIDS). Together we will end AIDS. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS (UNAIDS). 2012. Available at http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/jc2296_unaids_togetherreport_2012_en.pdf.

World Health Organization. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. Geneva, Switzerland: WHO Department of HIV/AIDS; 2013.

United Nations. New York. Millenium Development Goals Report. 2015. www.un.org/en/development/desa/publications/mdg-report-2015.html. Accessed 07 December 2015.

Bryce J, Black RE, Victora CG. Millennium development goals 4 and 5: progress and challenges. BMC Med. 2013 Oct 16;11:225. doi:10.1186/1741–7015–11–225.

Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, et al. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post −2015 priorities: an updated systematic analysis. Lancet Jan. 2015;385:430–40.CrossRef

10.

Lambert JS, Watts DH, Mofenson L, Stiehm ER, Harris DR, Bethel J, et al. Risk factors for preterm birth, low birth weight, and intrauterine growth retardation in infants born to HIV-infected pregnant women receiving zidovudine. Pediatric AIDS Clinical Trials Group 185 Team. AIDS. 2000 Jul 7;14(10):1389–99.

11.

Tuomala RE, Shapiro D, Mofenson L, et al. Pregnancy and the risk of an adverse outcome. N Engl J Med. 2002;346(24):1863.CrossRefPubMed

12.

Cotter AM, Garcia AG, Duthely ML, Luke B, O’Sullivan MJ. Is antiretroviral therapy during pregnancy associated with an increased risk of preterm delivery, low birth weight, or stillbirth? J Infect Dis. 2006;193:1195–201.CrossRefPubMed

13.

Turner AN, Tabbah S, Mwapasa V, Rogerson SJ, Meshnick SR, Ackerman IV W, et al. Severity of maternal HIV-1 disease is associated with adverse birth outcomes in Malawian women: a cohort study. J AIDS. 2013;64(4):392–9.

14.

Habib NA, Daltveit AK, Bergsjø P, Shao J, Oneko O, Lie RT. Maternal HIV status and pregnancy outcomes in northeastern Tanzania: a registry-based study. BJOG. 2008 Apr;115(5):616–24. doi:10.1111/j.1471–0528.2008.01672.x.

15.

Chen JY, Ribaudo HJ, Souda S, Parekh N, Ogwu A, Lockman S, et al. Highly active antiretroviral therapy and adverse birth outcomes among HIV-infected women in Botswana. J Infect Dis. 2012;206(11):1695–705.CrossRefPubMedPubMedCentral

16.

Fowler MG, Qin M, Fiscus SA, for the Promise Study Team, et al. PROMISE: Efficacy and Safety of Two Strategies to Prevent Perinatal HIV Transmission. Washington DC: Paper presented at: 22nd Conference on Retroviruses and Opportunistic Infections (CROI 2015); 2015.

17.

Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379(9832):2162–72. doi:10.1016/S0140–6736(12)60820–4.CrossRefPubMed

18.

van der Merwe K, Chersich M, Black V, Technau K, Rees H, Coovadia A. Birth outcomes in South African women receiving highly active antiretroviral therapy: a retrospective observational study. J Int AIDS Soc. 2011;14:42.CrossRefPubMedPubMedCentral

19.

Ravizza M, Martinelli P, Bucceri A, Fiore S, Alberico S, Tamburrini E, et al. Treatment with protease inhibitors and coinfection with hepatitis C virus are independent predictors of preterm delivery in HIV-infected pregnant women. J Infect Dis. 2007;195(6):913–4. author reply 6–7.CrossRefPubMed

20.

Bussmann H, Wester CW, Wester CN, Lekoko B, Okezie O, Thomas AM, et al. Pregnancy rates and birth outcomes among women on efavirenz-containing highly active antiretroviral therapy in Botswana. J Acquir Immune Defic Syndr. 2007;45(3):269–73.PubMed

21.

Ekouevi DK, Coffie PA, Ouattara E, Moh R, Amani-Bosse C, Messou E, et al. Pregnancy outcomes in women exposed to efavirenz and nevirapine: an appraisal of the IeDEA West Africa and ANRS Databases, Abidjan, Cote d’Ivoire. J Acquir Immune Defic Syndr. 2011;56(2):183–7.CrossRefPubMedPubMedCentral

22.

Matambo J, Moodley D, Moodley J. HIV Seroprevalence and Rapid testing in Unbooked Pregnant African Women. Int J Obstet Gynaecol. 1999;66:289–90.CrossRef

23.

Lindsay MK, Feng TI, Peterson HB, Slade BA, Willis S, Klein L. Routine human immunodeficiency virus infection screening in unregistered and registered inner-city parturients. Obstet Gynecol. 1991;77(4):599–603.PubMed

24.

Fawcus SR, Crowther CA, Van Baelen P, Marumahoko J. Booked and unbooked mothers delivering at Harare Maternity Hospital, Zimbabwe: a comparison of maternal characteristics and foetal outcome. Cent Afr J Med. 1992;38(10):402–8.PubMed

25.

Osungbade KO, Ayinde OO. Birth outcomes among booked and unbooked women at a secondary health facility in southwest Nigeria: implications for strengthening perinatal health services. J Child Health Care. 2011 Dec;15(4):320–8. doi:10.1177/1367493511406569. Epub 2011 Aug 9.

Title: Improved pregnancy outcomes with increasing antiretroviral coverage in South Africa
Authors: Theron Moodley
Dhayendre Moodley
Motshedisi Sebitloane
Niren Maharaj
Benn Sartorius
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-016-0821-3

At a glance: The STEP trials

Springer Medicine

Improved pregnancy outcomes with increasing antiretroviral coverage in South Africa

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2016

Benefits and harms of screening for and treatment of asymptomatic bacteriuria in pregnancy: a systematic review

Previous induced abortion among young women seeking abortion-related care in Kenya: a cross-sectional analysis

Survival analysis and prognostic factors of timing of first childbirth among women in Nigeria

Delivering care under uncertainty: Swiss providers’ experiences in caring for women with spinal cord injury during pregnancy and childbirth – an expert interview study

Characteristics of a global classification system for perinatal deaths: a Delphi consensus study

Factors associated with severe maternal morbidity in Kelantan, Malaysia: A comparative cross-sectional study