Relationship between HIV Status of Pregnant Women andLBW of Newborn
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摘要:
目的 分析HIV阳性孕妇所生新生儿的低出生体重(low birth weight,LBW)情况及其相关的危险因素。 方法 选择2013年1月至2018年5月于昆明市第三人民医院住院分娩的194例HIV阳性孕妇为研究对象。孕妇信息包括人口特征、妇产科病史、抗逆转录病毒药物史、HIV传播途径以及HIV疾病状况(包括入组时的CD4计数、HIV RNA病毒载量和血红蛋白)。采用Logistic回归分析确定与LBW相关的危险因素。 结果 在194名婴儿中,38例(19.6%)为LBW(< 2500 g)。LBW婴儿与非LBW婴儿在入组体重、怀孕期间抗逆转录病毒药物治疗、入组CD4计数、入组HIV RNA病毒载量和分娩时孕龄差异均有统计学意义(P < 0.05)。多变量Logistic回归分析显示,入组时体重轻(OR = 2.14,95% CI = 0.84~4.05,P = 0.013)、入组时CD4计数(OR = 6.02,95% CI = 1.50~24.13,P < 0.001)、入组时HIV RNA病毒载量(OR = 3.34,95% CI = 1.70~6.55,P < 0.001)和分娩时孕龄(OR = 12.90,95% CI = 2.03~81.88,P < 0.001)是LBW的独立危险因素。 结论 孕妇HIV疾病状况与新生儿LBW相关。HIV的产前筛查和诊断,对于早期预防和治疗HIV母婴传播,减少不良妊娠结局至关重要。 -
关键词:
- 低出生体重(LBW) /
- 怀孕 /
- 危险因素 /
- HIV阳性 /
- 产前抗逆转录病毒治疗
Abstract:Objective To analyze the low birth weight(LBW)situation and related risk factors of newborns born to HIV-positive pregnant women. Methods A total of 194 HIV-positive pregnant women who were hospitalized in Kunming Third People's Hospital for delivery from January 2013 to May 2018 were selected as the research subjects. Information on pregnant women includes demographic characteristics, history of obstetrics and gynecology, history of antiretroviral drugs, HIV transmission route, and HIV disease status(including CD4 count, HIV RNA viral load and hemoglobin at the time of enrollment). Logistic regression analysis was used to determine the risk factors related to LBW. Results Among 194 infants, 38(19.6%)were LBW(< 2500 g). There were significant differences between LBW infants and non-LBW infants in entry weight, antiretroviral treatment during pregnancy, entry CD4 count, entry HIV RNA viral load and gestational age at delivery(P < 0.05). Multivariate logistic regression analysis showed that the body weight was light at entry(OR = 2.14, 95% CI = 0.84~4.05, P = 0.013), and CD4 count at entry(OR = 6.02, 95% CI = 1.50~24.13, P < 0.001), HIV RNA viral load at entry(OR = 3.34, 95% CI = 1.70~6.55, P < 0.001)and gestational age at delivery(OR = 12.90, 95% CI = 2.03~81.88, P < 0.001)were independent risk factor for LBW. Conclusions The status of HIV disease in pregnant women is related to neonatal LBW. Prenatal screening and diagnosis of HIV are essential for the early prevention and treatment of mother-to-child transmission of HIV and reducing adverse pregnancy outcomes. -
Key words:
- Low birth weight /
- Pregnancy /
- Risk factors /
- HIV positive /
- Prenatal antiretroviral therapy
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表 1 不同出生体重新生儿母亲的基本特征比较[n(%)]
Table 1. Comparison of the basic characteristics of mothers with different birth weights [n(%)]
产妇基本特征 n(%) < 2 500 g(n = 38) ≥ 2 500 g(n = 156) χ2 P 年龄(岁) 2.842 0.242 < 25 92(47.4) 15(39.5) 77(49.4) 25~29 60(30.9) 11(28.9) 49(31.4) ≥ 30 42(21.7) 12(31.6) 30(19.2) 民族 0.012 0.972 汉族 123(63.4) 24(63.2) 99(63.5) 少数民族 71(36.6) 14(36.8) 57(36.5) 入组体重(kg) 12.193 0.002* < 45 12(6.2) 5(13.2) 7(4.5) 45~49 90(46.4) 24(63.2) 66(42.3) ≥ 50 92(47.4) 9(23.6) 83(53.2) 妊娠史(次) 0.242 0.622 < 2 85(43.8) 18(47.4) 67(43.0) ≥ 2 109(56.2) 20(52.6) 89(57.0) 分娩史(次) 0.032 0.858 0 130(67.0) 25(65.8) 105(67.3) ≥ 1 64(33.0) 13(34.2) 51(32.7) 分娩方式 1.355 0.508 剖腹产 108(55.7) 18(47.4) 90(57.7) 紧急剖腹产 14(7.2) 3(7.9) 11(7.1) 阴道分娩 72(37.1) 17(44.7) 55(35.2) HIV传播途径 2.918 0.088 吸毒 17(8.8) 6(15.8) 11(7.1) 性 177(91.2) 32(84.2) 145(92.9) *P < 0.05。 表 2 不同出生体重新生儿母亲怀孕时用药情况比较[n(%)]
Table 2. Comparison of medications used by mothers of different birth weights during pregnancy [n(%)]
产妇用药情况 总例数 < 2 500 g(n = 38) ≥ 2 500 g(n = 156) χ2 P 怀孕前/怀孕期间服用复方新诺明 0.087 0.767 否 176(90.7) 34(89.5) 142(91.0) 是 18(9.3) 4(10.5) 14(9.0) 怀孕期间抗逆转录病毒药物治疗 8.041 0.018* HAART 139(71.7) 34(89.5) 105(67.3) 临产时用药 25(12.9) 3(7.9) 22(14.1) 否 30(15.5) 1(2.6) 29(18.6) *P < 0.05。 表 3 不同出生体重新生儿母亲入组检测指标比较[n(%)]
Table 3. Comparison of detection indexes of mothers with different birth weights [n(%)]
产妇入组检测指标 总例数 < 2 500 g(n =38) ≥ 2 500 g(n = 156) χ2 P 入组时CD4计数(个细胞/μL) 18.474 0.001* < 100 12(6.2) 7(18.4) 5(3.2) 100~199 26(13.4) 9(23.7) 17(10.9) 200~349 68(35.1) 11(28.9) 57(36.5) ≥ 350 88(44.3) 11(28.9) 77(49.4) 入组时HIV RNA病毒载量(拷贝/μL) 6.063 0.048* < 20 81(41.8) 12(31.6) 69(44.2) 20~99 70(36.1) 11(28.9) 55(35.3) ≥ 100 43(22.1) 15(39.5) 32(20.5) 入组Hb(g/L) 0.258 0.611 < 100 45(23.2) 10(26.3) 35(22.4) ≥ 100 149(76.8) 28(73.7) 121(77.6) *P < 0.05。 表 4 不同出生体重新生儿基本特征比较[n(%)]
Table 4. Comparison of basic characteristics of newborns with different birth weights [n(%)]
新生儿基本特征 总例数 < 2 500 g(n = 38) ≥ 2 500 g(n = 156) χ2 P 分娩时孕龄(周) 10.321 0.001* ≥ 37 175(90.2) 29(76.3) 146(93.6) < 37 19(9.8) 9(23.7) 10(6.4) 婴儿的HIV状况 1.252 0.263 阳性 13(6.7) 1(2.6) 12(7.7) 阴性 181(93.3) 37(97.4) 144(92.3) *P < 0.05。 表 5 LBW的危险因素的多变量分析
Table 5. Multivariate analysis of risk factors for LBW
危险因素 β Wald/χ2 OR 95% CI P 产妇入院年龄 0.147 2.015 1.31 0.88~1.96 0.193 入组时体重 −1.432 4.875 2.14 0.84~4.05 0.013 HIV传播途径 −0.893 0.004 0.96 0.77~1.18 0.373 怀孕期间抗逆转录病毒药物治疗 −0.907 2.406 1.74 0.88~3.45 0.118 入组时CD4计数 1.116 61.394 6.02 1.50~24.13 < 0.001 入组时HIV RNA病毒载量 0.129 68.752 3.34 1.70~6.55 < 0.001 分娩时孕龄 0.074 82.390 12.90 2.03~81.88 < 0.001 婴儿的HIV状况 1.823 2.147 1.26 0.94~1.69 0.203 产妇入院年龄:< 25岁 = 1,25~29岁 = 2,≥ 30岁 = 3;入组时体重:< 45 kg = 1,45~49 kg = 2,≥ 50 kg = 3;HIV传播途径:吸毒 = 1,性 = 2;怀孕期间抗逆转录病毒药物治疗:是 = 1,否 = 2;入组时CD4计数:< 100个细胞/μL = 1,100~199个细胞/μL = 2,200~349个细胞/μL = 3,≥ 350个细胞/μL= 4;入组时HIV RNA病毒载量:< 20拷贝/μL = 1,20~99拷贝/μL = 2,≥ 100拷贝/μL = 3;分娩时孕龄:≥ 37周 = 1,< 37周 = 2;婴儿的HIV状况:阳性 = 1,阴性 = 2。 -
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