THE ASSOCIATION BETWEEN MATERNAL HIV-INFECTION AND PERINATAL OUTCOME - A SYSTEMATIC REVIEW OF THE LITERATURE AND METAANALYSIS

Objective To investigate the association between maternal HIV infectio n and perinatal outcome by a systematic review of the literature and m eta-analysis. Methods Appropriate publications were identified using e lectronic and hand searching of relevant journals from 1983 to 1996. S tudies were included in the review if they were prospective cohorts wi th pregnant women identified as being HIV-infected with a control grou p of pregnant women who were not infected with HIV. Methodological qua lity was assessed for each study. Data were extracted for pre-determin ed outcome measures. Sensitivity analyses were performed to explore th e association between HIV infection and an adverse perinatal outcome f or the following study characteristics: clinical setting (developed or developing countries), methodological quality (high or poor) and whet her studies controlled for potential confounding. Results Thirty-one s tudies were eligible to be included in the review The summary odds rat io of the risk of pre-defined adverse perinatal outcomes related to ma ternal HIV infection were as follows: spontaneous abortion 4.05 (95% C I 2.75-5.96); stillbirth 3.91 (95% CI 2.65-5.77); fetal abnormality 1. 08 (95% CI 0.7-1.66); perinatal mortality 1.79 (95% CI 1.14-2.81); neo natal mortality 1.10 (95% CI 0.63-1.93); infant mortality 3.69 (95% CI 3.03-4.49); intrauterine growth retardation 1.7 (95% CI 1.43-2.02); l ow birthweight 2.09 (95% CI 1.86-2.35) and pre-term delivery 1.83 (95% CI 1.63-2.06). Sensitivity analyses showed that the association betwe en infant mortality and maternal HIV infection was stronger in studies conducted in developing countries when compared with developed countr ies [odds ratios (OR) 3.72 (95% CI 3.05-4.54) and 8.6 (95% CI 0.53-141 .05), respectively]; studies of higher methodological quality compared with those of poorer quality [odds ratios 14.57 (95% CI 6.93-30.65) a nd 3.37 (95% CI 2.74-4.14), respectively] and studies which had used r estriction or matching to control for potential confounding factors co mpared with those that had not [OR 11.60 (95% CI 5.71-23.58) and 3.35 (95% CI 2.73-4.12), respectively]. Conclusions The findings of this re view have implications for women infected with HIV who are planning a pregnancy or who find themselves pregnant. There appears to be an asso ciation, although not strong, between maternal HIV infection and an ad verse perinatal outcome. This relationship may be due to bias includin g uncontrolled or residual confounding. There does, however, appear to be a real and large increase in the risk of infant death in developin g countries associated with maternal HIV infection, especially so when there has been an attempt to control for confounding.