Rate , correlates and outcomes of repeat pregnancy in HIV-infected women

Floridia, M.; Tamburrini, E.; Masuelli, G.; Martinelli, P.; Spinillo, A.; Liuzzi, G.; Vimercati, A.; Alberico, S.; Maccabruni, A.; Pinnetti, C.; Frisina, V.; Dalzero, S.; Ravizza, M.; Mori, F.; Ortolani, P.; dalle Nogare, E. R.; Di Lorenzo, F.; Sterrantino, G.; Meli, M.; Polemi, S.; Nocentini, J.; Baldini, M.; Montorzi, G.; Mazzetti, M.; Rogasi, P.; Borchi, B.; Vichi, F.; Del Pin, B.; Pinter, E.; Anzalone, E.; Marocco, R.; Mastroianni, C.; Mercurio, V. S.; Carocci, A.; Grilli, E.; Zaramella, M.; Mariani, B.; Natalini Raponi, G.; Guaraldi, G.; Nardini, G.; Stentarelli, C.; Beghetto, B.; Degli Antoni, A. M.; Molinari, A.; Crisalli, M. P.; Donisi, A.; Piepoli, M.; Cerri, V.; Zuccotti, G.; Giacomet, V.; Coletto, S.; Di Nello, F.; Madia, C.; Placido, G.; Vivarelli, A.; Castelli, P.; Savalli, F.; Portelli, V.; Sabbatini, F.; Francisci, D.; Bernini, L.; Grossi, P.; Rizzi, L.; Maso, G.; Airoud, M.; Soppelsa, G.; Meloni, A.; Dedoni, M.; Cuboni, C.; Ortu, F.; Piano, P.; Citernesi, A.; Bordoni Vicini, I.; Luzi, K.; Roccio, M.; Miccolis, A.; De Gennaro, A.; Guerra, B.; Cervi, F.; Simonazzi, G.; Margarito, E.; Capretti, M. G.; Marsico, C.; Faldella, G.; Sansone, M.; Agangi, A.; Capone, A.; Maruotti, M.; Tibaldi, C.; Trentini, L.; Todros, T.; Cetin, I.; Brambilla, T.; Savasi, V.; Personeni, C.; Giaquinto, C.; Fiscon, M.; Rubino, E.; Bucceri, A.; Matrone, R.; Scaravelli, G.; Genovese, O.; Cafforio, C.; Tozzi, V.; Massetti, P.; Casadei, A. M.; Cavaliere, A. F.; Cellini, M.; Castelli Gattinara, G.; Marconi, A. M.; Sacchi, V.; Ierardi, M.; Polizzi, C.; Mattei, A.; Pirillo, M. F.; Amici, R.; Galluzzo, C. M.; Donnini, S.; Baroncelli, S.; Villani, P.; Cusato, M.; Cerioli, A.; De Martino, M.; Mastroiacovo, P.; Parazzini, F.; Vella, S.

doi:10.1111/hiv.12473

Objectives: The aim of the study was to assess the rate, determinants, and outcomes of repeat pregnancies in women with HIV infection. Methods: Data from a national study of pregnant women with HIV infection were used. Main outcomes were preterm delivery, low birth weight, CD4 cell count and HIV plasma viral load. Results: The rate of repeat pregnancy among 3007 women was 16.2%. Women with a repeat pregnancy were on average younger than those with a single pregnancy (median age 30 vs. 33 years, respectively), more recently diagnosed with HIV infection (median time since diagnosis 25 vs. 51 months, respectively), and more frequently of foreign origin [odds ratio (OR) 1.36; 95% confidence interval (CI) 1.10–1.68], diagnosed with HIV infection in the current pregnancy (OR: 1.69; 95% CI: 1.35–2.11), and at their first pregnancy (OR: 1.33; 95% CI: 1.06–1.66). In women with sequential pregnancies, compared with the first pregnancy, several outcomes showed a significant improvement in the second pregnancy, with a higher rate of antiretroviral treatment at conception (39.0 vs. 65.4%, respectively), better median maternal weight at the start of pregnancy (60 vs. 61 kg, respectively), a higher rate of end-of-pregnancy undetectable HIV RNA (60.7 vs. 71.6%, respectively), a higher median birth weight (2815 vs. 2885 g, respectively), lower rates of preterm delivery (23.0 vs. 17.7%, respectively) and of low birth weight (23.4 vs. 15.4%, respectively), and a higher median CD4 cell count (+47 cells/μL), with almost no clinical progression to Centers for Disease Control and Prevention stage C (CDC-C) HIV disease (0.3%). The second pregnancy was significantly more likely to end in voluntary termination than the first pregnancy (11.4 vs. 6.1%, respectively). Conclusions: Younger and foreign women were more likely to have a repeat pregnancy; in women with sequential pregnancies, the second pregnancy was characterized by a significant improvement in several outcomes, suggesting that women with HIV infection who desire multiple children may proceed safely and confidently with subsequent pregnancies.