The Effect of HIV-Centered Obstetric Care on Perinatal Outcomes among a Cohort of Women Living with HIV

Anna Powell, Julia M. DeVita, Amartha Ogburu-Ogbonnaya, Andrea Peterson, Gweneth B. Lazenby

Research output: Contribution to journalArticle

Abstract

Background: Elimination of perinatal transmission is possible but limited by missed care opportunities. Our objective was to investigate the effects of HIV-centered obstetric care (HCC) on missed care opportunities and perinatal HIV transmission in 2 obstetric cohorts at our institution from 2000 to 2014. Methods: This was a retrospective cohort study of HIV-exposed mother-infant pairs delivering from 2000 to 2014, analyzed according to SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guidelines. Before 2009, women received care in high-risk obstetric care (HRC); subsequently, an HCC service was established. Women who received HRC vs HCC obstetric care were compared to determine differences in maternal and neonatal outcomes. Continuous variables were compared with Student t test and Wilcoxon rank sum tests. Categorical variables were compared using χ 2 test and Fisher exact test. Logistic regression analyses were performed to determine factors associated with outcomes of interest. Results: Over 14 years, 161 women delivered 217 HIV-exposed infants; 78 (36%) women received HCC. Two perinatal HIV transmissions (1.5%) occurred in HRC group compared with none in the HCC group (P = 0.3). Women in HCC were more likely to have HIV RNA viral load <1000 copies per milliliter at delivery (12% vs 26%, P = 0.02), have a contraception plan before delivery (93% vs 60%, P < 0.001), return for postpartum evaluation (80% vs 63%, P = 0.01), and have undetectable HIV viral load postpartum (50 copies per milliliter vs 2067, P < 0.0001). Conclusions: HCC can potentially reduce the risk of perinatal HIV transmission by improving maternal virologic control during pregnancy and postpartum and increasing postpartum contraceptive use.

Original languageEnglish (US)
Pages (from-to)431-438
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume75
Issue number4
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

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Perinatal Care
Obstetrics
HIV
Postpartum Period
Mothers
Nonparametric Statistics
Viral Load
Contraceptive Agents
Quality Improvement
Contraception

Keywords

  • elimination of perinatal transmission
  • HIV
  • long-acting reversible contraception
  • missed care opportunities
  • prenatal care

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

The Effect of HIV-Centered Obstetric Care on Perinatal Outcomes among a Cohort of Women Living with HIV. / Powell, Anna; DeVita, Julia M.; Ogburu-Ogbonnaya, Amartha; Peterson, Andrea; Lazenby, Gweneth B.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 75, No. 4, 01.08.2017, p. 431-438.

Research output: Contribution to journalArticle

Powell, Anna ; DeVita, Julia M. ; Ogburu-Ogbonnaya, Amartha ; Peterson, Andrea ; Lazenby, Gweneth B. / The Effect of HIV-Centered Obstetric Care on Perinatal Outcomes among a Cohort of Women Living with HIV. In: Journal of Acquired Immune Deficiency Syndromes. 2017 ; Vol. 75, No. 4. pp. 431-438.
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abstract = "Background: Elimination of perinatal transmission is possible but limited by missed care opportunities. Our objective was to investigate the effects of HIV-centered obstetric care (HCC) on missed care opportunities and perinatal HIV transmission in 2 obstetric cohorts at our institution from 2000 to 2014. Methods: This was a retrospective cohort study of HIV-exposed mother-infant pairs delivering from 2000 to 2014, analyzed according to SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guidelines. Before 2009, women received care in high-risk obstetric care (HRC); subsequently, an HCC service was established. Women who received HRC vs HCC obstetric care were compared to determine differences in maternal and neonatal outcomes. Continuous variables were compared with Student t test and Wilcoxon rank sum tests. Categorical variables were compared using χ 2 test and Fisher exact test. Logistic regression analyses were performed to determine factors associated with outcomes of interest. Results: Over 14 years, 161 women delivered 217 HIV-exposed infants; 78 (36{\%}) women received HCC. Two perinatal HIV transmissions (1.5{\%}) occurred in HRC group compared with none in the HCC group (P = 0.3). Women in HCC were more likely to have HIV RNA viral load <1000 copies per milliliter at delivery (12{\%} vs 26{\%}, P = 0.02), have a contraception plan before delivery (93{\%} vs 60{\%}, P < 0.001), return for postpartum evaluation (80{\%} vs 63{\%}, P = 0.01), and have undetectable HIV viral load postpartum (50 copies per milliliter vs 2067, P < 0.0001). Conclusions: HCC can potentially reduce the risk of perinatal HIV transmission by improving maternal virologic control during pregnancy and postpartum and increasing postpartum contraceptive use.",
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