Name: HELENA LUCIA BARROSO DOS REIS
Type: PhD thesis
Publication date: 25/06/2020
Advisor:
Name |
Role |
|---|---|
| ANGELICA ESPINOSA BARBOSA MIRANDA | Advisor * |
Examining board:
| Name |
Role |
|---|---|
| ANGELICA ESPINOSA BARBOSA MIRANDA | Advisor * |
| CRISPIM CERUTTI JUNIOR | Internal Examiner * |
| MOISES PALACI | Internal Examiner * |
Summary: Introduction. Fetal growth and placental disorders are common in the maternal infection by HIV and can be assigned to both the infection as well as to comorbidities not associated with the virus. In addition to being perinatal morbidity determinants, they constitute markers of abnormal intra-uterine environment and possible post-natal care diseases, including diseases in adult life. There are several studies on fetal growth restriction, however, little is known about the prevalence and severity of placental growth disorders in pregnant women infected by HIV.
Objective. The aim of this study is to describe the placental growth disorders and the adverse reproductive outcome in pregnant women infected by HIV and to verify its relationship with the severity of maternal infection and the use of antiretrovirals.
Patients and methods. A cross-sectional study in pregnant women infected by HIV who had fetal and concepts annexes available, whose terminations ocured between November 2001 and November 2014, attended in a university hospital in Vitória, Espírito Santo. One hundred-twenty-two cases were included, with gestational age (GA) equal to or greater than 154 days (22 weeks) post-menstrual, validated by ultrasonography, with clinical and laboratory data available, and whose dimensions in placental and fetal weight at birth were measured. For the evaluation of the dimensions in placental and fetal weight, in relation to the reference values, it was used: small (SGA), appropriate (AGA), and large (LGA) for the GA, when the values were below -1.28 between -1.28 and +1.28 or above + 1.28 score z, respectively, corresponding to the clinical cut-off points that demarcate the 10th and 90th percentiles. Births occurring before 37 weeks were considered preterm. Cases with unreliable gestational age, unavailable fetal weight at birth and misplaced fetal attachments were excluded.
Results. Out of the 187 cases with located fetal attachments requisitions in the period of the study, we included a total of 122 pregnant women and newborns of HIV-infected women, with median age of 28 years (interquartile range IQR: 24-32 years), 81.9% with at least one earlier gestation (100/122), 66.4 % with six or more pre-natal visits (81/122), 66.4 % with HIV infection diagnosed before the current pregnancy (81/122), 56.5% with criteria for AIDS (69/122) and 52.4% with detectable viral load (64/122). The median count of lymphocytes T-CD4+ was 446 cells/mm3 (IQ = 318-620). We observed SGA placental weight in 20.5% of cases (25/122) and SGA placental thickness in 9.3% (12/122). The SGA placental area was observed in 33.6% (41/122), and among SGA placental weight cases, 48% (12/25) were SGA fetal weight cases. SGA weight placentas had the highest proportion of SGA placental thickness (P = 0.003). Preterm birth was observed in 15,6% of the cases and perinatal death in 4.9% of cases.
Thirty-six years old and older women had 5.7 times higher probability of having preterm birth when compared to those younger than 36 years old. Moreover, patients with criteria for aids definition had 3.7 times higher probability of having preterm birth. The number of prenatal care attendances was inversely associated with preterm birth. Statistically significative associations were observed between AGA placentas and the usage of protease inhibitors, and between SGA placental weight and area.
Conclusion. A high occurrence of placentas with a SGA weight and SGA area was observed related to SGA fetal weight. There was an association of the no SGA placental area with the use of PI. There was a higher occurrence of SGA fetal weight in the SGA placental weight cases. Preterm birth and perinatal death were more common than in the general population in HIV-infected women, and there was an association between pre-term labour and prenatal care attendances, maternal age and Apgar score lower than seven in the first minute. The restriction of placental growth was a common disorder, possibly attributed to virus effects or a combination of antiretroviral regimens.
