抗病毒治疗的HIV感染妇女妊娠率及分娩结局的研究

Study of pregnancy rate and birth outcomes among women receiving antiretroviral therapy

目的研究抗病毒治疗（ART）的艾滋病病毒（HIV）感染妇女的妊娠率及分娩结局。方法收集2008年1月至2017年6月于深圳市第三人民医院接受ART的HIV感染妇女,停经≥28周定义为分娩,孕周〈28周定义为流产,28周≤孕周〈37周定义为早产,37周≤孕周〈42周定义为足月产。结果共收集HIV感染妇女1 089例,年龄分布在16~48岁,平均年龄32岁。有生育要求的497人,其中268人妊娠,妊娠率53.9%（268/497）。分娩196人（73.1%）（包括早产11例）,流产72人（26.9%）,剖宫产（其中双胞胎1例）169人,阴道分娩27人,活产率100%。低出生体重儿7例（3.6%）,无1例新生儿畸形率及窒息,新生儿HIV感染率为0。结论抗病毒治疗的HIV感染妇女的妊娠率偏低,分娩结局通常良好,孕期应用抗病毒药物相对安全。生育期HIV感染妇女的治疗应包括生育指导及孕期多学科的联合治疗,才能有效降低HIV的母婴传播,减少母婴不良结局的发生。

Objective To study the pregnancy rate and birth outcomes among women receiving antiretroviral therapy.Methods we selected women in childbearing age receiving ART and followed up in the third people＇s hospital of Shenzhen from Jan 2008 to Jun 2017.Childbirth was defined by the expulsion of a fetus after 28 weeks of amenorrhea,and an abortion（ 28 w）,premature（≥28 wand 37 w）,and full-time birth（≥37 wand 42 w）.Results A total of 1089 women of childbearing were observed.Their age ranged between 16 and 48 years with a median of 32 years.Among the 497 women recorded in expect of pregnancy,53.9%（268/497）got pregnant,73.1%（196/268）ended with childbirth（including 11 premature births）,and 26.9%（72/268）with abortion.169 pregnant women chose cesarean section（including one twin）and 27 chose vaginal delivery.Live birth and HIV infection rates of neonates were 100% and 0%.There were 7 neonates with low birth weight,and there was no cases of asphyxia and malformation.Conclusion This study shows a low pregnancy incidence among women initiating ART.Pregnancies that occurred during ART generally end well.It is relatively safe to apply antiviral drugs during pregnancy.Care packages for HIV infected women of childbearing age must include reproductive health services to reduce mother to child HIV transmission,so as to decrease adverse birth outcomes.