Effect of Hiv-1 infection on pregnancy outcome in women in Kigali, Rwanda, 1992–1994

The effect of antenatal services including malaria and sexually transmitted disease (STD) treatment on pregnancy outcome was evaluated in HIV-positive women recruited in the last 3 months of pregnancy from the antenatal ward of the Centre Hospitalier de Kigali Rwanda in 1992-93. Until delivery these 384 HIV-infected women and 381 age- and parity-matched HIV-negative controls from the same facility received monthly malaria and STD diagnosis and treatment. At least one STD was diagnosed in the study period in 144 cases (39.6%) and 100 controls (27.4%); the malaria rates were 20.9% and 15.9% respectively. Maternal and neonatal outcomes at delivery and at 6 weeks postpartum were also compared. There were 10 stillbirths among HIV-positive women (2.7%) and 8 (2.2%) among controls. Excluding twins (n = 14) 22.7% of infants born to HIV-positive women compared with 14.1% of those born to HIV-negative controls were premature (<37 weeks) and 25.5% and 14.8% respectively were of low birth weight (<2500 g). Multivariate analysis indicated that 24% of cases of prematurity were directly attributable to HIV infection. Adjusting for prematurity HIV-positive women were 1.8 times more likely than controls to have a low-birth-weight infant and when stratified by gestational age infants of mothers in the former group were 2.0 times more likely than infants of controls to have intrauterine growth retardation. However in the multivariate analysis only genital ulcerations and anemia remained significant risk factors for intrauterine growth retardation. Anthropometric measurements (mean birth weight head circumference and length) were significantly lower in the infants of HIV-positive mothers. Finally 5 HIV-positive women but no controls had postpartum hemorrhage. Thus even with an intervention to control malaria and STDs HIV infection increased the risk of prematurity by 62% and that of low birth weight by 58%. Systematic implementation of a program of STD and malaria treatment as part of prenatal care is still recommended however to decrease the frequency of adverse pregnancy outcomes in populations with a high HIV prevalence among women.