Impact of pregnancy on maternal AIDS
Kumar, R.M.; Uduman, S.A.; Khurrana, A.K.
Journal of Reproductive Medicine 42(7): 429-434
1997
ISSN/ISBN: 0024-7758 PMID: 9252934 Document Number: 268653
The effects of pregnancy on maternal AIDS were investigated in a prospective study (1992-96) of 71 HIV-positive tribal women from Manipur, India. 32 women (49%) were pregnant during the study period. Both pregnant and non-pregnant women were matched in terms of age, parity, CD4 lymphocyte counts, and demographic attributes. The most frequent AIDS-defining illnesses were Pneumocystis carinii pneumonia (PCP), miliary tuberculosis, and wasting syndrome. 3 pregnant women with PCP died after early induced abortion and another 13 died undelivered at 30-36 weeks' gestation; the remaining 14 women vaginally delivered a preterm infant at 28-35 weeks' gestation. As pregnancy progressed, these women's CD4 counts declined in association with their AIDS-related clinical deterioration. 11 of the 14 infants died within 6 weeks of delivery. 2 of the 14 surviving HIV-infected mothers died of fulminating PCP within 3 weeks of delivery. Overall, 18 (56%) of the HIV-infected pregnant women died within 17 months of becoming pregnant as a result of a rapidly progressing AIDS-defining illness, while only 10 (26%) of the non-pregnant women with AIDS died within 42 months of their AIDS diagnosis. The mean survival time was 9.72 months in the former group and 22.6 months in the latter group. These findings indicate that pregnancy in women with AIDS has a significant detrimental effect on both maternal and obstetric outcome and accelerates disease progression. Large prospective, multicenter studies of pregnant HIV-infected women would facilitate better understanding of the variables determining disease progression and clinical outcomes in both mother and child.