Open Collections

UBC Faculty Research and Publications

Investigation of Factors Associated with Spontaneous Preterm Birth in Pregnant Women Living with HIV Albert, Arianne; Elwood, Chelsea; Wagner, Emily C.; Pakzad, Zahra; Chaworth-Musters, Tessa; Berg, Kyra; Van Schalkwyk, Julie; Maan, Evelyn J.; Azampanah, Arezou; McClymont, Elisabeth; Alimenti, Ariane; Forbes, John C.; Money, Deborah M.

Abstract

Objective: To investigate factors contributing to preterm birth (PTB), including cART use and clinical and social determinants of health, in women living with HIV (WLWH) from British Columbia, Canada. Design: Retrospective observational cohort. Methods: We investigated the effect of cART use and other clinical and demographic factors on spontaneous PTB (sPTB) rates (<37 weeks gestational age) among 631 singleton pregnancies between 1997-2018. Exposure to cART was modelled in comparison to no exposure, exposure in the first trimester, and between regimens. Differences in sPTB risk were estimated using time52 dependent Cox’s proportional hazards models. Results: Overall, the sPTB rate was 16%. Cumulative cART use was associated with lower risk of PTB (Wald test p=0.02; HR=0.98, 95% CI=0.96-0.99) and specific cART regimens were not associated with increased risk of sPTB. Exposure in the first trimester was not associated with sPTB and for each week of cART exposure, the risk of sPTB decreased by 2%. In a multivariable model, HIV viral load and substance use remained associated with risk of sPTB, but not cART exposure. Conclusions: The sPTB rate among pregnant WLWH was more than three times higher than in the general population. However, sPTB was not related specifically to use of cART; in fact, cART appeared to reduce the risk of sPTB. Uncontrolled HIV replication and substance use were associated with increased risk of sPTB among pregnant WLWH. This emphasizes the important role of prenatal care, access to cART, and smoking cessation and harm reduction to reduce the risk of sPTB in WLWH.

Item Metadata

Title
Investigation of Factors Associated with Spontaneous Preterm Birth in Pregnant Women Living with HIV
Creator
Albert, Arianne; Elwood, Chelsea; Wagner, Emily C.; Pakzad, Zahra; Chaworth-Musters, Tessa; Berg, Kyra; Van Schalkwyk, Julie; Maan, Evelyn J.; Azampanah, Arezou; McClymont, Elisabeth; Alimenti, Ariane; Forbes, John C.; Money, Deborah M.
Contributor
Women's Health Research Institute (British Columbia)
Publisher
Wolters Kluwer
Date Issued
2020-04-01
Description
Objective: To investigate factors contributing to preterm birth (PTB), including cART use and clinical and social determinants of health, in women living with HIV (WLWH) from British Columbia, Canada. Design: Retrospective observational cohort. Methods: We investigated the effect of cART use and other clinical and demographic factors on spontaneous PTB (sPTB) rates (<37 weeks gestational age) among 631 singleton pregnancies between 1997-2018. Exposure to cART was modelled in comparison to no exposure, exposure in the first trimester, and between regimens. Differences in sPTB risk were estimated using time52 dependent Cox’s proportional hazards models. Results: Overall, the sPTB rate was 16%. Cumulative cART use was associated with lower risk of PTB (Wald test p=0.02; HR=0.98, 95% CI=0.96-0.99) and specific cART regimens were not associated with increased risk of sPTB. Exposure in the first trimester was not associated with sPTB and for each week of cART exposure, the risk of sPTB decreased by 2%. In a multivariable model, HIV viral load and substance use remained associated with risk of sPTB, but not cART exposure. Conclusions: The sPTB rate among pregnant WLWH was more than three times higher than in the general population. However, sPTB was not related specifically to use of cART; in fact, cART appeared to reduce the risk of sPTB. Uncontrolled HIV replication and substance use were associated with increased risk of sPTB among pregnant WLWH. This emphasizes the important role of prenatal care, access to cART, and smoking cessation and harm reduction to reduce the risk of sPTB in WLWH.
Subject
Preterm birth; Women; HIV; Antiretroviral therapy
Genre
Article; Postprint
Type
Text
Language
eng
Date Available
2021-04-01
Provider
Vancouver : University of British Columbia Library
Rights
Attribution-NonCommercial 4.0 International
DOI
10.14288/1.0394540
URI
http://hdl.handle.net/2429/76197
Affiliation
Medicine, Faculty of; Other UBC; Obstetrics and Gynaecology, Department of; Pediatrics, Department of
Citation
Albert AYK, Elwood C, Wagner EC, Pakzad Z, Chaworth-Musters T, Berg K, Van Schalkwyk J, Maan EJ, Azampanah A, McClymont E, Alimenti A, Forbes JC, Money DM. Investigation of factors associated with spontaneous preterm birth in pregnant women living with HIV. AIDS. 2020 Apr 1;34(5):719-727
Publisher DOI
10.1097/QAD.0000000000002464
Peer Review Status
Reviewed
Scholarly Level
Faculty; Researcher; Graduate
Rights URI
http://creativecommons.org/licenses/by-nc/4.0/
Aggregated Source Repository
DSpace

Item Media

Item Citations and Data

Rights

Attribution-NonCommercial 4.0 International