MATERNAL HUMAN IMMUNODEFICIENCY VIRUS-1 INFECTION AND PREGNANCY OUTCOME

Objective: To study the impact of maternal human immunodeficiency viru s type 1 (HIV-1) infection on pregnancy outcome. Methods: Between janu ary 1989 and December 1991, 406 HIV-1-seropositive and 407 HIV-1-seron egative age- and parity-matched pregnant women from Nairobi, Kenya, al l at less than 28 weeks' gestation, were recruited into a prospective study of HIV-1 infection in pregnant women and their offspring. Both g roups were followed until 6 weeks postpartum. Results: Three hundred f ifteen HIV-1-seropositive women and 311 HIV-1-seronegative controls we re followed until delivery. Seropositive women were younger at sexual debut and reported more lifetime partners and more sexually transmitte d diseases (STDs) than the seronegative controls. The seropositive wom en had higher rates of genital ulcer disease (4.7 versus 2.0%; P = .08 ), genital warts (4.9 versus 2.0%; P = .03), and positive syphilis ser ology (7.9 versus 3.2%; P < .001), but there were no differences betwe en the groups in isolation rates of Neisseria gonorrhoeae (6.8 versus 7.1%) and Chlamydia trachomatis (11.5 versus 9.0%). Maternal HIV-1 inf ection was associated with significantly lower birth weight (2913 vers us 3072 g; P = .0003) and with prematurity (21.1 versus 9.4%; P < .000 1), but not with small for gestational age size (4.2 versus 3.2%; P = .7). The stillbirth rate was higher in seropositive women, yet not sta tistically significant (3.8 versus 1.9%; P = .2). Women with a CD4 cou nt lower than 30% had a higher risk of preterm delivery (26.3 versus 1 0.1%; P < .001). Postpartum endometritis was more common in HIV-1-infe cted women than in seronegative controls (10.3 versus 4.2%; P = .01) a nd was inversely correlated with the CD4 percentage. No histopathologi c placental abnormalities attributable to HIV-1 were detected. Conclus ion: Maternal HIV-1 infection was significantly associated with premat urity and postpartum endometritis, but not with fetal growth retardati on. There was a trend toward a higher stillbirth rate in HIV-1-seropos itive mothers.