Health  Vol.5 No.7 D , July 2013
Birth outcome and correlates of low birth weight and preterm delivery among infants born to HIV-infected women in public hospitals of Northwest Ethiopia

Background: HIV-positive pregnant women are at an increased risk of adverse pregnancy outcomes. However, data on birth outcome among HIV-infected women are limited in Ethiopia. This study was conducted to identify the adverse birth outcomes and associated factors of low birth weight (LBW) and preterm delivery (PD) among HIV-infected women. Methods: A hospital based retrospective cohort study was conducted. All deliveries from HIV-infected women from September 1, 2009 to April 30, 2012 were included in the study. Multivariate logistic regression was performed to explore the potential risk factors for LBW and PD. Result: Out of 416 singleton infants born to HIV-infected mothers, the prevalence of LBW and PD was 89 (21.4%) and 69 (16.6%), respectively. The baseline maternal CD4 counts below 200 cells/mm3, maternal body mass index (BMI) below 18.5, maternal anemia and maternal exposure to Highly Active Antiretroviral Treatment (HAART) were factors significantly associated with LBW. On the other hand, a baseline maternal CD4 level below 200/ mm3, having no Prevention of Mother-to-Child Transmission (PMTCT) intervention during pregnancy, maternal BMI less than 18.5, maternal Eclamsia during pregnancy, and mothers being on HAART before pregnancy were factors associated with preterm delivery. Conclusion: There was a significant prevalence of low birth weight and preterm delivery among infants born to HIV-positive mothers. The programme for PMTCT services should maximize the need for an early identification of those mothers with predicted complications.

Cite this paper: Kebede, B. , Andargie, G. and Gebeyehu, A. (2013) Birth outcome and correlates of low birth weight and preterm delivery among infants born to HIV-infected women in public hospitals of Northwest Ethiopia. Health, 5, 25-34. doi: 10.4236/health.2013.57A4004.

[1]   UNAIDS WHO (2009) AIDS epidemic update. World Health Organization.

[2]   UNAIDS/WHO (2008) Report on the Global AIDS Epidemic. World Health Organization, Geneva.

[3]   UNAIDS 2012 Report: Regional Fact Sheet.

[4]   The United States President’s Emergency Plan for HIV/ AIDS Relief, Ethiopia Country Operational Plan 2007, April, 2007.

[5]   Central Statistical Agency [Ethiopia] and ICF International (2012) Ethiopia Demographic and Health Survey 2011. Central Statistical Agency and ICF International, Addis Ababa, Ethiopia and Calverton, Maryland.

[6]   Federal HIV/AIDS Prevention and Control Office (2011) Prevention of Mother to Child Transmission 2010.

[7]   Tilahun Nigatu, Y.W. (2011) Analysis of the Prevention of Mother-to-Child Transmission (PMTCT) service utilization in Ethiopia: 2006-2010. Reproductive Health, 8, 6. http://wwwreproductive-health-journalcom/content/8/1/6

[8]   World Health Organization (2010) Antiretroviral drugs for treating pregnant women and preventing hiv infection in infants. Recommendations for a Public Health Approach, World Health Organization.

[9]   WHO (2010) Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector. Progress Report.

[10]   Towards Universal Access Progress.

[11]   Hargrove, J.W. and Humphrey, J.H. (2010) ZS G: Mortality among HIV-positive postpartum women with high CD4 cell counts in Zimbabwe. AIDS, 24, F11-F14. doi:10.1097/QAD.0b013e328335749d

[12]   Kourtis, A.P. (2010) Antiretroviral drug use during pregnancy and risk of premature delivery: Is there a connection? The Journal of Infectious Diseases, 201, 978-980. doi:10.1086/651233

[13]   Patrice Tchendjou, C.S.-E., Annie, N., Mathurin, T., Anfumbom, K., Anne, N.N., Landry, T., Anne, C.B., Daniel, E., Joanna, O.-G., Dominique, R., Regis, P. and Francois, D. (2010) Effectiveness of multidrug antiretroviral regimens to prevent mother-to-child transmission of HIV-1 in routine public health services in Cameroon. PLoS ONE, 5.

[14]   Hoosen, C. (2004) Antiretroviral agents—How best to protect infants from HIV and save their mothers from AIDS. New England Journal of Medicine, 351, 289-292. doi:10.1056/NEJMe048128

[15]   Kourtis, A.P.S.C., Jamieson, D.J. and Lau, J. (2007) Use of antiretroviral therapy in pregnant HIV-infected women and the risk of premature delivery: A meta-analysis. AIDS, 21, 607-615. doi:10.1097/QAD.0b013e32802ef2f6

[16]   Nigel, C., Rollins, H.M.C., et al. (2007) Pregnancy outcomes in HIV-infected and uninfected women in rural and urban South Africa. Journal of Acquired Immune Deficiency Syndromes, 44, 321-328. doi:10.1097/QAI.0b013e31802ea4b0

[17]   Denise Naniche, A.B., María, L., Anna, B., Inacio, M., Sergi, S., John, J.A., Betuel, S, Pedro, L.A. and Clara, M. (2009) Impact of maternal human immunodeficiency virus infection on birth outcomes and infant survival in rural Mozambique. The American Journal of Tropical Medicine and Hygiene, 80, 870-876.

[18]   Federal HIV/AIDS Prevention and Control Office (2007) Guidelines for prevention of mother-to-child transmission of HIV in Ethiopia.

[19]   Yu, L., Li, W.Y., Chen, R.Y., Tang, Z.R., Pang, J., Gui, X.Z., Meng, X.N. and Zhang, F.J. (2012) Pregnancy outcomes and risk factors for low birth weight and preterm delivery among HIV-infected pregnant women in Guangxi, China. Chinese Medical Journal, 125, 403-409.

[20]   Chen, J. (2009) Risk factors for adbverse pregnancy outcomes among HIV infected women in Gaborone, Botswana. 16th Conference on Retroviruses and Opportunistic Infections, Montreal, 2009.

[21]   Machado, E.S.H.C., Costa, T.T., et al. (2009) Pregnancy outcome in women infected with HIV-1 receiving combination antiretroviral therapy before versus after conception. Sexually Transmitted Infections, 85, 82-87. doi:10.1136/sti.2008.032300

[22]   Karin van der Merwe, R.H., Vivian, B., Matthew, C., Ashraf, C. and Helen, R. (2011) Birth outcomes in South African women receiving highly active antiretroviral therapy: A retrospective observational study. Journal of the International AIDS Society, 14, 42.

[23]   Rollins, N.C.C.H., Bland, R.M., Coutsoudis, A., Bennish, M.L., Patel, D. and Newell, M.L. (2007) Pregnancy outcomes in HIV infected and uninfected women in rural and urban South Africa. Journal of Acquired Immune Deficiency Syndromes, 44, 321-328. doi:10.1097/QAI.0b013e31802ea4b0

[24]   Langston, C.L.D., Hammill, H.A., Popek, E.J., Kozinetz, C.A., Kline, M.W., Hanson, I.C. and Shearer, W.T. (1995) Excess intrauterine fetal demise associated with maternal human immunodeficiency virus infection. The Journal of Infectious Diseases, 172, 1451-1460. doi:10.1093/infdis/172.6.1451

[25]   United Nations Children’s Fundand World Health Organization (2004) Low birth weight: Country, regional and global estimates. UNICEF, New York.

[26]   (2012) Care of the preterm and/or low-birth-weight newborn.

[27]   Tegegne, B.A., Enquoselassie, F. and Yusuf, L. (2010) Birth to pregnancy interval and its effect on perinatal outcomes in Addis Ababa, Ethiopia. Ethiopian Journal of Reproductive Health, 4, 37-51.

[28]   Megabiaw, B., Zelalem, M. and Mohammed, N. (2012) Incidence and correlates of low birth weight at a referral hospital in Northwest Ethiopia. The Pan African Medical Journal, 12, 14.

[29]   Laar, A.K., Ampofo, W., Tuakli, J.M., Norgbe, G.K. and Quakyi, I.A. (2010) Preterm delivery and low birth weight among neonates born to HIV-positive and HIV-negative Ghanaian women. Journal of Public Health and Epidemiology, 2, 224-237.

[30]   Darin Areechokchai, C.B., Benjaluck, P., Punnee, P. and Wirach, M.-a-N. (2009) Pregnancy outcomes among HIV-infected women undergoing antiretroviral therapy. The Open AIDS Journal, 3, 8-13.

[31]   Stratton, P.T.R., Abboud, R., et al. (1999) Obstetric and newborn outcomes in a cohort and HIV-infected pregnant women: A report of the women and infants transmission study. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 20, 179-186. doi:10.1097/00042560-199902010-00011

[32]   Powis, K.M., Kitch, D., Ogwu, A., Hughes, M.D., Lockman, S., Leidner, J., Widenfelt, E., Moffat, C., Moyo, S., Makhema, J. et al. (2011) Increased risk of preterm delivery among HIV infected women randomized to protease versus nucleoside reverse transcriptase inhibitor-based HAART during pregnancy. Journal of Infectious Diseases, 204, 506-514. doi:10.1093/infdis/jir307

[33]   Braddick, M.R.K.J., Embree, J.B., et al. (1990) Impact of maternal HIV infection on obstetrical and early neonatal outcome. AIDS, 4, 1001-1005. doi:10.1097/00002030-199010000-00009

[34]   Katia Kastetbon, J.L., Valeriane, L. et al. (1999) Low birth weight in infant born to African HIV-infected Women: Relationship with maternal body weight during pregnancy. Journal of Tropical Pediatrics, 45.

[35]   The Kesho Bora Study Group (2010) Eighteen-month follow-up of HIV-1—Infected mothers and their children enrolled in the kesho bora study observational cohorts. Journal of Acquired Immune Deficiency Syndrome, 54, 533-541.

[36]   Kowalska, A.N.T., El Midaoui, A. and Burkacka, E. (2003) Effect of antiretroviral therapy on pregnancy outcome in HIV-1 positive women. Med Wieku Rozwoj, 7, 459-468.

[37]   Ekouevi, D.K.C.P., Becquet, R., Tonwe-Gold, B., Horo, A., Thiebaut, R., Leroy, V., Blanche, S., Dabis, F. and Abrams, E.J. (2008) Antiretroviral therapy in pregnant women with advanced HIV disease and pregnancy outcomes in Abidjan, Cote d’Ivoire. Aids, 22, 1815-1820. doi:10.1097/QAD.0b013e32830b8ab9

[38]   Mehta, S., Manji, K.P., Young, A.M., Brown, E.R., Chasela, C., Taha, T.E., Read, J.S., Goldenberg, R.L. and Fawzi, W.W. (2008) Nutritional indicators of adverse pregnancy outcomes and mother-to-child transmission of HIV among HIV-infected women. American Journal of Clinical Nutrition, 87, 1639-1649.

[39]   Joseph, O., Biodun, O. and Michael, E. (2011) Pregnancy outcome among HIV positive women receiving antenatal HAART versus untreated maternal HIV infection. Journal of College of Physicians and Surgeons Pakistan, 21, 356-359.

[40]   Thorne, C.P.D. and Newell, M.L. (2004) For the European collaborative study. Increased risk of adverse pregnancy outcomes in HIV-infected women treated with highly active antiretroviral therapy in Europe. AIDS, 18, 2337-2339. doi:10.1097/00002030-200411190-00019

[41]   European Collaborative Study SMaCCS (2000) Combination antiretroviral therapy and duration of pregnancy. AIDS, 14, 2913-2920. doi:10.1097/00002030-200012220-00013