湖南省2011-2017年孕产妇HIV感染者早产、低出生体重和小于胎龄儿发生率及其影响因素分析

Prevalence and associated risk factors on preterm birth, low birth weight, and small for gestational age among HIV-infected pregnant women in Hunan province, 2011-201

目的了解湖南省孕产妇HIV感染者早产、低出生体重（LBW）和小于胎龄儿（SGA）的发生状况并探讨其影响因素。方法以2011年1月至2017年12月湖南省预防艾滋病母婴传播管理信息系统报告的已分娩的孕产妇HIV感染者为研究对象，对其人口学特征、妊娠情况、抗病毒治疗（ART）、丈夫/性伴情况和妊娠结局等因素进行分析，分别计算早产、LBW和SGA发生率，采用多因素logistic回归分析其相关影响因素。结果共纳入780例孕产妇HIV感染者，其早产率为7.9%（62/780），LBW发生率为9.9%（77/780），SGA发生率为21.3%（166/780）。孕产妇HIV感染者早产的危险因素包括妊娠期中重度贫血、妊娠期高血压疾病、〈14孕周开始ART（与孕期未进行ART相比）和丈夫/性伴年龄〉35岁（与26-30岁相比），其aOR值分别为4.59（95%CI：1.51-13.95）、4.90（95%CI：1.56-15.46）、2.40（95%CI：1.26-4.56）和2.29（95%CI：1.21-4.36）。妊娠期中重度贫血、妊娠合并HBV感染和〈14孕周开始ART（与孕期未进行ART相比）是LBW的危险因素，其aOR值分别为3.28（95%CI：1.13-9.54）、4.37（95%CI：1.42-13.44）和2.68（95%CI：1.51-4.76）。妊娠合并HBV感染和〈14孕周开始ART（与孕期未进行ART相比）是SGA的危险因素，其aOR值分别为4.41（95%CI：1.43-13.63）和2.67（95%CI：1.51-4.73）。结论早产、LBW和SGA是湖南省孕产妇HIV感染者常见的不良妊娠结局，受妊娠合并症、ART和丈夫/性伴的年龄等因素影响。

Objective To describe the prevalence of preterm birth （PB）, low birth weight （LBW）, and small for gestational age （SGA） among HIV-infected pregnant women and to identify associated risk factors in Hunan province.Methods This study appeared a retrospective one on HIV-infected pregnant women retrieved from Information System of Prevention of Mother-to-child Transmission of HIV management in Hunan province, between January 2011 and December 2017. Information regarding demographic characteristics, pregnancy, antiretroviral therapy （ART）, husbands/partners’ relevant situation and pregnancy outcomes, among these HIV-infected pregnant women were collected and analyzed. The incidence rates on PB, LBW and SGA were calculated. Multivariate logistic regression was used to analyze the associated risk factors.Results A total of 780 HIV-infected pregnant women were enrolled. The prevalence rates on PB, LBW and SGA in HIV- infected pregnant women appeared as 7.9% （62/780）, 9.9% （77/780） and 21.3% （166/780）, respectively. Results from the multivariate logistic regression analysis showed that factors as pregnancy related diseases as moderate/severe anemia, hypertensive, initial time of ART 〈14 gestational weeks （compared to those women without ART during pregnancy） and husbands/partners’ age 〉35 years old （compared to husbands/partners’ age 26-30 years old） etc., were associated with an increased risk of PB with adjusted OR as 4.59 （95%CI： 1.51-13.95）, 4.90 （95%CI： 1.56-15.46）, 2.40 （95%CI： 1.26- 4.56） and 2.29 （95%CI： 1.21-4.36）. For LBW, pregnancy moderate/severe anemia, pregnancy HBV infection and initial time of ART 〈14 gestational weeks were associated with an increased risk of LBW, with adjusted OR as 3.28 （95%CI： 1.13-9.54）, 4.37 （95%CI： 1.42-13.44） and 2.68 （95%CI： 1.51-4.76）, respectively. For SGA, pregnancy HBV infection and initial time of ART 〈14 gestational weeks were risk factors for SGA, with adjusted OR as 4.41 （95%CI： 1.43-13.63） and 2.67 （95%CI： 1.51-4.73）, respectively.Conclusion Preterm birth, LBW and SGA were common adverse pregnancy outcomes for HIV-infected pregnant women and were associated with factors as pregnancy complications, ART and husbands/partners’ age.