PREGNANCY OUTCOME IN WOMEN WITH BETA-THALASSEMIA MAJOR AND HIV-INFECTION

Objectives. To conduct a study of maternal and foetal outcome in pregn ant transfusion-dependent beta-thalassemia major (P-TM) women with HIV -1 disease. Study design. The course and outcome of pregnancy was stud ied prospectively in 123 women with transfusion-dependent beta-thalass emia major, of which 81 were HIV-1 positive, at Sanjay Gandhi hospital Manipur, India, from January 1990 to January 1997. The clinical and i mmunological status of the seropositive women was compared with matche d seronegative thalassemic control groups. Results. Over a period of 7 years, 123 women with beta-TM conceived. One hundred and eleven (90%) conceptions were spontaneous including the 81 HIV-1 positive women an d 12 (10%) conceptions occurred after induction of ovulation. Among th ese 81 patients the following stages of HIV-1 infection were represent ed: 39 C2 stage (AIDS indicator conditions); 42 A2 stage (asymptomatic ) (CDC 1993). Of these 39 women, 12/39 (31%) underwent medical termina tion of pregnancy (MTP) by 8 weeks gestation and five (13%) died undel ivered by 32 weeks gestation due to fulminating pneumocystis carinii p neumonia. There were 80/123 (65%) singleton vaginal deliveries of whic h 22/80 (28%) were preterm and 58 (71%) term. All 22 preterm births oc curred in mothers with aids indicator conditions, were vaginal deliver ies, and they had positive viral cultures for HIV-1 within one week of birth. Ten of these neonates died by 8 weeks of AIDS and the remainin g 12 died of AIDS indicator disease by 15 months of age. At term a sig nificant 25% (31/123) of women delivered by elective caesarean section due to cephalopelvic disproportion. Except for those inflicted with A IDS, the remaining women remained well throughout pregnancy. Conclusio n. Successful outcome of pregnancies does occur in women with beta-TM and also in those with asymptomatic HIV disease. Associated AIDS indic ator conditions cause appreciable perinatal and maternal morbidity and mortality. (C) 1998 Elsevier Science Ireland Ltd.