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Oral Concurrent Session 2 Infectious Disease www.AJOG.org
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Benefit of inter-pregnancy HIV viral load suppression onsubsequent maternal and infant outcomesRobert Stewart1, C. Edward Wells1, Scott Roberts1,Vanessa Rogers1, Barbara McElwee1, Donald McIntire1,Jeanne Sheffield11University of Texas Southwestern Medical Center, Obstetrics andGynecology, Dallas, TXOBJECTIVE: To determine if inter-pregnancy HIV viral load sup-pression affects outcomes in subsequent pregnancies.STUDY DESIGN: This is a retrospective review of all women whodelivered two consecutive pregnancies at our institution whilediagnosed with HIV from January 1, 1984 until January 1, 2012.Medical records were reviewed for maternal, infant, and deliverydata. Pregnancies were divided into first and second pregnancy, andinter-pregnancy interval was defined as the time from delivery of thefirst pregnancy to presentation of the second pregnancy.
S14 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2
RESULTS: During the study period 172 HIV infected women wereidentified who delivered two pregnancies during the study period.There was no difference in median HIV viral load at presentation ordelivery between first and second pregnancies. During the secondpregnancy more women presented on antiretroviral therapy (ART)and more often remained compliant with ART, however the secondpregnancy was associated with greater vertical transmission (3 v 6%,p¼0.003). During the inter-pregnancy interval HIV viral loadsincreased by a median 182 copies/mL, and CD4 counts decreased bya median of 54. Of those with a viral load <1000 copies/mL at theend of their first pregnancy (N¼103), 57 (55%) presented for theirsecond pregnancy with viral loads still <1000 copies/mL. There wasno difference in the inter-pregnancy interval between these groups.Those women who maintained viral load suppression betweenpregnancies were more likely to present for their second pregnancyon ART, maintained greater viral load suppression and CD4 countsat delivery, and had fewer vertical transmissions compared to thosewho re-presented with higher viral loads (0 vs. 7%, p¼0.02).CONCLUSION: Maintaining viral load suppression between pregnan-cies improves HIV disease status at delivery in subsequent preg-nancies. Inter-pregnancy HIV viral load suppression is associatedwith less vertical transmission, emphasizing the importance ofmaintaining HIV disease control between pregnancies.
Data presented as N (%), mean � SD, or median [Q1, Q3].
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Acute parvovirus infection in pregnancy: are weunderestimating the risk?Lydia Simmons1, Naomi Burke1, Etaoin Kent1, Fergal Malone11Royal College of Surgeons in Ireland, Obstetrics and Gynaecology, Dublin,IrelandOBJECTIVE: To describe the natural history of parvovirus infection inpregnancy and evaluate influence of gestational age at seroconver-sion on fetal outcomes.STUDY DESIGN: A retrospective cohort study was performed evalu-ating maternal parvovirus infection over a 2 year period in a tertiaryfetal medicine unit. Cases were identified from laboratory and pre-natal diagnosis databases. Demographic data and pregnancy out-comes were collected. Fetal anemia was defined as an increase inmiddle cerebral artery Doppler peak systolic velocity, or sonographicevidence of fetal hydrops. Rates of fetal anemia, need for intrauterinetransfusion (IUT) and intra-uterine fetal demise (IUFD) werecompared between those that seroconverted prior to and after20 weeks gestation.RESULTS: Of 434 patients screened for parvovirus, 39.2% (n¼170)were IgG negative. The rate of seroconversion was 15.3% (n¼26) inthese 170 non-immune patients. Outcome data were available for 20of these 26 cases. 55% (n¼11) of seroconverted patients had sono-graphic evidence of fetal anemia, 6 underwent IUT, 1 IUFD occcuredprior to planned IUT and spontaneous resolution occurred in 36.4%(n¼4). Rate of IUFD following acute infection was 15% (3/20).
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