OBJECTIVE: To describe the incidence and predictors of stillbirth in a predominantly human immunodeficiency virus (HIV)-infected African cohort. METHODS: Human Immunodeficiency Virus (HIV) Prevention Trials Network (HPTN) 024 was a randomized controlled trial of empiric antibiotics to reduce chorioamnionitis-related perinatal HIV transmission. A proportion of HIV-uninfected individuals were enrolled to reduce community-based stigma surrounding the trial. For this analysis, only women who gave birth to singleton infants were included. RESULTS: Of 2,659 women enrolled, 2,434 (92%) mother- child pairs met inclusion criteria. Of these, 2,099 (86%) infants were born to HIV-infected women, and 335 (14%) were born to HIV-uninfected women. The overall stillbirth rate was 32.9 per 1,000 deliveries (95% confidence interval [CI] 26.1-40.7). In univariable analyses, predictors for stillbirth included previous stillbirth (odds ratio [OR] 2.3, 95% CI 1.2-4.3), antenatal hemorrhage (OR 14.4, 95% CI 4.3-47.9), clinical chorioamnionitis (OR 20.9, 95% CI 5.1-86.2), and marked polymorphonuclear infiltration on placental histology (OR 2.9, 95% CI 1.7-5.2). When compared with pregnancies longer than 37 weeks, those at 34-37 weeks (OR 1.7, 95% CI 0.8-3.4) and those at less than 34 weeks (OR 22.8, 95% CI 13.6-38.2) appeared more likely to result in stillborn delivery. Human immunodeficiency virus infection was not associated with a greater risk for stillbirth in either univariable (OR 1.5, 95% CI 0.7-3.0) or multivariable (adjusted OR 1.11, 95% CI 0.38-3.26) analysis. Among HIV-infected women, however, decreasing CD4 cell count was inversely related to stillbirth risk (P=.009). CONCLUSION: In this large cohort, HIV infection was not associated with increased stillbirth risk. Further work is needed to elucidate the relationship between chorioamnionitis and stillbirth in African populations. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00021671 LEVEL OF EVIDENCE: II.
RCT Entities:
OBJECTIVE: To describe the incidence and predictors of stillbirth in a predominantly human immunodeficiency virus (HIV)-infected African cohort. METHODS:Human Immunodeficiency Virus (HIV) Prevention Trials Network (HPTN) 024 was a randomized controlled trial of empiric antibiotics to reduce chorioamnionitis-related perinatal HIV transmission. A proportion of HIV-uninfected individuals were enrolled to reduce community-based stigma surrounding the trial. For this analysis, only women who gave birth to singleton infants were included. RESULTS: Of 2,659 women enrolled, 2,434 (92%) mother- child pairs met inclusion criteria. Of these, 2,099 (86%) infants were born to HIV-infectedwomen, and 335 (14%) were born to HIV-uninfectedwomen. The overall stillbirth rate was 32.9 per 1,000 deliveries (95% confidence interval [CI] 26.1-40.7). In univariable analyses, predictors for stillbirth included previous stillbirth (odds ratio [OR] 2.3, 95% CI 1.2-4.3), antenatal hemorrhage (OR 14.4, 95% CI 4.3-47.9), clinical chorioamnionitis (OR 20.9, 95% CI 5.1-86.2), and marked polymorphonuclear infiltration on placental histology (OR 2.9, 95% CI 1.7-5.2). When compared with pregnancies longer than 37 weeks, those at 34-37 weeks (OR 1.7, 95% CI 0.8-3.4) and those at less than 34 weeks (OR 22.8, 95% CI 13.6-38.2) appeared more likely to result in stillborn delivery. Human immunodeficiency virus infection was not associated with a greater risk for stillbirth in either univariable (OR 1.5, 95% CI 0.7-3.0) or multivariable (adjusted OR 1.11, 95% CI 0.38-3.26) analysis. Among HIV-infectedwomen, however, decreasing CD4 cell count was inversely related to stillbirth risk (P=.009). CONCLUSION: In this large cohort, HIV infection was not associated with increased stillbirth risk. Further work is needed to elucidate the relationship between chorioamnionitis and stillbirth in African populations. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00021671 LEVEL OF EVIDENCE: II.
Authors: C Engmann; A Garces; I Jehan; J Ditekemena; M Phiri; M Mazariegos; E Chomba; O Pasha; A Tshefu; E M McClure; V Thorsten; H Chakraborty; R L Goldenberg; C Bose; W A Carlo; L L Wright Journal: J Perinatol Date: 2011-11-10 Impact factor: 2.521
Authors: Malango T Msukwa; Olivia Keiser; Andreas Jahn; Joep J van Oosterhout; Andrew Edmonds; Nozgechi Phiri; Ronald Manjomo; Mary-Ann Davies; Janne Estill Journal: Trop Med Int Health Date: 2019-04-01 Impact factor: 2.622
Authors: Kristina Adachi; Jeffrey D Klausner; Claire C Bristow; Jiahong Xu; Bonnie Ank; Mariza G Morgado; D Heather Watts; Fred Weir; David Persing; Lynne M Mofenson; Valdilea G Veloso; Jose Henrique Pilotto; Esau Joao; Karin Nielsen-Saines Journal: Sex Transm Dis Date: 2015-10 Impact factor: 2.830
Authors: Eleanor Turnbull; Mwila K Lembalemba; M Brad Guffey; Carolyn Bolton-Moore; Mwangelwa Mubiana-Mbewe; Namwinga Chintu; Mark J Giganti; Mutinta Nalubamba-Phiri; Elizabeth M Stringer; Jeffrey S A Stringer; Benjamin H Chi Journal: Trop Med Int Health Date: 2011-04-07 Impact factor: 2.622
Authors: Roland Kupka; Tarik Kassaye; Elmar Saathoff; Ellen Hertzmark; Gernard I Msamanga; Wafaie W Fawzi Journal: Acta Obstet Gynecol Scand Date: 2009 Impact factor: 3.636
Authors: Sidra Ishaque; Mohammad Yawar Yakoob; Aamer Imdad; Robert L Goldenberg; Thomas P Eisele; Zulfiqar A Bhutta Journal: BMC Public Health Date: 2011-04-13 Impact factor: 3.295