Pregnancy outcomes in HIV infected and uninfected women in urban and rural South Africa

Objective: To describe pregnancy outcomes amongst clade C HIV-infected and uninfected women in South Africa Design: A longitudinal cohort study Methods: Pregnant women attending 9 rural/urban antenatal clinics were prospectively recruited and followed-up Results: 3465 women enrolled; 615 withdrew antenatally, moved away or had missing/indeterminate HIV status, leaving 2850 women (1449 HIV infected). There were six antenatal women deaths, 17 spontaneous abortions and 104 stillbirths. Adverse pregnancy outcome was independently associated with HIV infection (AOR 1.63, p=0.015), urban enrolment (AOR 0.39, p=0.020) and non-hospital delivery (AOR 13.63, p<0.001), and among infected women with CD4<200 (AOR 1.86, p=0.127). Amongst 2529 singleton liveborn infants birth weight was inversely associated with maternal HIV (AOR, 1.45, p=0.02) and maternal mid-upper arm circumference (AOR=0.93, p<0.001). Early infant mortality was not significantly associated with maternal HIV (HR 1.18, p=0.52), but was with urban sites (HR 0.34, p=0.045). Low birth weight substantially increased mortality (AOR 8.3, p<0.001). HIV status of infants by 8 weeks (14.6%, 95% CI 12.5-17.0%) was inversely associated with maternal CD4 count and birth weight. Conclusions: HIV-infected women are at significantly increased risk of adverse pregnancy outcomes. Low birth weight infants of both infected and uninfected women are at substantially increased risk of dying.