Effect of HIV-1 infection on pregnancy outcome in women in Kigali, Rwanda, 1992-1994

Objective: To study the effect of HIV-1 infection on pregnancy outcome in women provided with antenatal services including malaria and sexually transmitted disease (STD) treatment in Kigali, Rwanda. Subjects and methods: Pregnant women attending the antenatal clinic ward of the Centre Hospitalier de Kigali in their last 3 months of pregnancy were tested for HIV antibody after consent had been obtained. All HIV-1-infected women were included and compared with HIV-negative women of same age and parity. Until delivery, each woman enrolled had a monthly follow-up including malaria and STD aetiological diagnosis and treatment. At the time of delivery, obstetrical and neonatal characteristics were recorded. Mothers and their children were followed until 6 weeks postpartum. Results: By mid-August 1993, 384 HIV-positive and 381 HIV-negative women had been enrolled and by the end of November 1993, 729 women (95.3%; 364 HIV-positive and 365 HIV-negative) had delivered 725 livebirths, including eight and six twins, respectively; 10 stillbirths were recorded amongst HIV-positive women and eight amongst HIV-negative women (P = 0.60). Excluding twins, premature birth (< 37 completed weeks of gestation) was observed in 22.7% of infants born to HIV-positive women versus 14.1% of those born to HIV-negative women; low birth weight (< 2500 g) was observed in 25.5% of infants born to HIV-positive women versus 14.8% of those born to HIV-negative women. Low birth weight was significantly more frequent in full-term infants born to HIV-positive mothers than to HIV-negative mothers. No significant difference in low birth weight rate was observed in preterm infants. Death occurred in 5.1% of children during the perinatal period without statistically significant difference between the two groups. HIV-positive women were more likely to have a postpartum haemorrhage. Conclusion: In the context of high HIV prevalence, maternal HIV infection is associated with adverse obstetrical and neonatal outcomes even when treating STD and malaria.