Maternal HIV Infection and Spontaneous versus Provider-Initiated Preterm Birth in an Urban Zambian Cohort

Citation

Price, Joan T.; Vwalika, Bellington; Edwards, Jessie K.; Cole, Stephen R.; Kasaro, Margaret P.; Rittenhouse, Katelyn J.; Kumwenda, Andrew; Lubeya, Mwansa K.; & Stringer, Jeffrey S. A. (2021). Maternal HIV Infection and Spontaneous versus Provider-Initiated Preterm Birth in an Urban Zambian Cohort. Journal of Acquired Immune Deficiency Syndrome, 87(2), 860-868. PMCID: PMC8131221

Abstract

OBJECTIVE: We investigated the effect of maternal HIV and its treatment on spontaneous and provider-initiated preterm birth (PTB) in an urban African cohort.
METHODS: The Zambian Preterm Birth Prevention Study enrolled pregnant women at their first antenatal visit in Lusaka. Participants underwent ultrasound, laboratory testing, and clinical phenotyping of delivery outcomes. Key exposures were maternal HIV serostatus and timing of antiretroviral therapy initiation. We defined the primary outcome, PTB, as delivery between 16 and 37 weeks' gestational age, and differentiated spontaneous from provider-initiated parturition.
RESULTS: Of 1450 pregnant women enrolled, 350 (24%) had HIV. About 1216 (84%) were retained at delivery, 3 of whom delivered <16 weeks. Of 181 (15%) preterm deliveries, 120 (66%) were spontaneous, 56 (31%) were provider-initiated, and 5 (3%) were unclassified. In standardized analyses using inverse probability weighting, maternal HIV increased the risk of spontaneous PTB [RR 1.68; 95% confidence interval (CI): 1.12 to 2.52], but this effect was mitigated on overall PTB [risk ratio (RR) 1.31; 95% CI: 0.92 to 1.86] owing to a protective effect against provider-initiated PTB. HIV reduced the risk of preeclampsia (RR 0.32; 95% CI: 0.11 to 0.91), which strongly predicted provider-initiated PTB (RR 17.92; 95% CI: 8.13 to 39.53). The timing of antiretroviral therapy start did not affect the relationship between HIV and PTB.
CONCLUSION: The risk of HIV on spontaneous PTB seems to be opposed by a protective effect of HIV on provider-initiated PTB. These findings support an inflammatory mechanism underlying HIV-related PTB and suggest that published estimates of PTB risk overall underestimate the risk of spontaneous PTB.

URL

http://dx.doi.org/10.1097/QAI.0000000000002654

Reference Type

Journal Article

Year Published

2021

Journal Title

Journal of Acquired Immune Deficiency Syndrome

Author(s)

Price, Joan T.
Vwalika, Bellington
Edwards, Jessie K.
Cole, Stephen R.
Kasaro, Margaret P.
Rittenhouse, Katelyn J.
Kumwenda, Andrew
Lubeya, Mwansa K.
Stringer, Jeffrey S. A.

Article Type

Regular

PMCID

PMC8131221

Data Set/Study

Zambia Preterm Birth Prevention Study (ZAPPS)

Continent/Country

Zambia

Sex/Gender

Women

ORCiD

Edwards, J -0000-0002-1741-335X