OBSTETRIC AND PERINATAL OUTCOME IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PREGNANT-WOMEN WITH AND WITHOUT OPIATE ADDICTION

This study was undertaken to assess the impact on gestation played by the simple human immunodeficiency virus (HIV)seropositive status eithe r alone or complicated by opiate abuse in the absence of other confoun ding variables. To this purpose the main obstetric complications and t he perinatal outcome were prospectively evaluated in 38 simple HIV-inf ected women, 14 of whom were simple carriers and 24 under methadone tr eatment, and in 76 uninfected women, 16 of whom were methadone users a nd 60 controls. In simple HIV-carriers maternal weight gain (P < 0.001 ) and both 1- and 5-min Apgar scores (P < 0.005) were reduced whereas the incidence of miscarriage was increased (P < 0.05). Worse obstetric and perinatal outcomes were found in HIV-seropositive drug addicts, i n which gestational length (P < 0.001), maternal weight gain (P < 0.00 1) and Apgar scores were lower (P < 0.005 and P < 0.001, respectively) and the rate of preterm labour, small for gestational age newborns, v aginal and urinary infections as well as of unexplained fever (P < 0.0 5) was higher. Outcomes were similar in HIV-seropositive and seronegat ive drug addicts and in both groups a positive correlation (r = 0.62 P < 0.001, and r = 0.44, respectively) was found between the number of infectious episodes throughout pregnancy and the mean dose of opiate c onsumed daily. Our results suggest that HIV-seropositive condition mig ht exert slight direct and indirect detrimental effects on pregnancy. Whatever the maternal serologic status, opiate intake not only causes a further worsening of gestational and perinatal outcomes, but also in creases the susceptibility towards pathogens.