Kristin M Wall1, Lisa B Haddad2, C Christina Mehta3, Elizabeth T Golub4, Lisa Rahangdale5, Jodie Dionne-Odom6, Roksana Karim7, Rodney L Wright8, Howard Minkoff9, Mardge Cohen10, Seble G Kassaye11, Deborah Cohan12, Igho Ofotokun13, Susan E Cohn14. 1. Department of Epidemiology, Rollins School of Public Heath, Emory University, Atlanta, GA. Electronic address: kmwall@emory.edu. 2. Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA. 3. Department of Biostatistics and Bioinformatics, Rollins School of Public Heath, Emory University, Atlanta, GA. 4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Heath, Baltimore, MD. 5. Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC. 6. Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL. 7. Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA. 8. Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY. 9. Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY. 10. Department of Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, IL; Rush University, Chicago, IL. 11. Department of Medicine, Division of Infectious Diseases and Travel Medicine, Georgetown University School of Medicine, Washington, DC. 12. Department of Obstetrics and Gynecology, University of California, San Francisco, School of Medicine, San Francisco, CA. 13. Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA; Grady Healthcare System, Atlanta, GA. 14. Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL.
Abstract
BACKGROUND: Relatively little is known about the frequency and factors associated with miscarriage among women living with HIV. OBJECTIVE: The objective of the study was to evaluate factors associated with miscarriage among women enrolled in the Women's Interagency HIV Study. STUDY DESIGN: We conducted an analysis of longitudinal data collected from Oct. 1, 1994, to Sept. 30, 2017. Women who attended at least 2 Women's Interagency HIV Study visits and reported pregnancy during follow-up were included. Miscarriage was defined as spontaneous loss of pregnancy before 20 weeks of gestation based on self-report assessed at biannual visits. We modeled the association between demographic, behavioral, and clinical covariates and miscarriage (vs live birth) for women overall and stratified by HIV status using mixed-model logistic regression. RESULTS: Similar proportions of women living with and without HIV experienced miscarriage (37% and 39%, respectively, P = .638). In adjusted analyses, smoking tobacco (adjusted odds ratio, 2.0), alcohol use (adjusted odds ratio, 4.0), and marijuana use (adjusted odds ratio, 2.0) were associated with miscarriage. Among women living with HIV, low HIV viral load (<4 log10 copies/mL) (adjusted odds ratio, 0.5) and protease inhibitor (adjusted odds ratio, 0.4) vs the nonuse of combination antiretroviral therapy use were protective against miscarriage. CONCLUSION: We did not find an increased odds of miscarriage among women living with HIV compared with uninfected women; however, poorly controlled HIV infection was associated with increased miscarriage risk. Higher miscarriage risk among women exposed to tobacco, alcohol, and marijuana highlight potentially modifiable behaviors. Given previous concern about antiretroviral therapy and adverse pregnancy outcomes, the novel protective association between protease inhibitors compared with non-combination antiretroviral therapy and miscarriage in this study is reassuring.
BACKGROUND: Relatively little is known about the frequency and factors associated with miscarriage among women living with HIV. OBJECTIVE: The objective of the study was to evaluate factors associated with miscarriage among women enrolled in the Women's Interagency HIV Study. STUDY DESIGN: We conducted an analysis of longitudinal data collected from Oct. 1, 1994, to Sept. 30, 2017. Women who attended at least 2 Women's Interagency HIV Study visits and reported pregnancy during follow-up were included. Miscarriage was defined as spontaneous loss of pregnancy before 20 weeks of gestation based on self-report assessed at biannual visits. We modeled the association between demographic, behavioral, and clinical covariates and miscarriage (vs live birth) for women overall and stratified by HIV status using mixed-model logistic regression. RESULTS: Similar proportions of women living with and without HIV experienced miscarriage (37% and 39%, respectively, P = .638). In adjusted analyses, smoking tobacco (adjusted odds ratio, 2.0), alcohol use (adjusted odds ratio, 4.0), and marijuana use (adjusted odds ratio, 2.0) were associated with miscarriage. Among women living with HIV, low HIV viral load (<4 log10 copies/mL) (adjusted odds ratio, 0.5) and protease inhibitor (adjusted odds ratio, 0.4) vs the nonuse of combination antiretroviral therapy use were protective against miscarriage. CONCLUSION: We did not find an increased odds of miscarriage among women living with HIV compared with uninfected women; however, poorly controlled HIV infection was associated with increased miscarriage risk. Higher miscarriage risk among women exposed to tobacco, alcohol, and marijuana highlight potentially modifiable behaviors. Given previous concern about antiretroviral therapy and adverse pregnancy outcomes, the novel protective association between protease inhibitors compared with non-combination antiretroviral therapy and miscarriage in this study is reassuring.
Authors: Gale A Richardson; Christopher Ryan; Jennifer Willford; Nancy L Day; Lidush Goldschmidt Journal: Neurotoxicol Teratol Date: 2002 May-Jun Impact factor: 3.763
Authors: L Stewart Massad; Gayle Springer; Lisa Jacobson; Heather Watts; Kathryn Anastos; Abner Korn; Helen Cejtin; Alice Stek; Mary Young; Julie Schmidt; Howard Minkoff Journal: AIDS Date: 2004-01-23 Impact factor: 4.177
Authors: R Raghupathy; E Al-Mutawa; M Al-Azemi; M Makhseed; F Azizieh; J Szekeres-Bartho Journal: J Reprod Immunol Date: 2009-04-15 Impact factor: 4.054
Authors: E Trabucco; G Acone; A Marenna; R Pierantoni; G Cacciola; T Chioccarelli; K Mackie; S Fasano; N Colacurci; R Meccariello; G Cobellis; L Cobellis Journal: Placenta Date: 2009-05-05 Impact factor: 3.481
Authors: Daniel Westreich; Jordan Cates; Mardge Cohen; Kathleen M Weber; Dominika Seidman; Karen Cropsey; Rodney Wright; Joel Milam; Mary A Young; C Christina Mehta; Deborah R Gustafson; Elizabeth T Golub; Margaret A Fischl; Adaora A Adimora Journal: AIDS Date: 2017-02-20 Impact factor: 4.177
Authors: Jean B Nachega; Olalekan A Uthman; Lynne M Mofenson; Jean R Anderson; Steve Kanters; Francoise Renaud; Nathan Ford; Shaffiq Essajee; Meg C Doherty; Edward J Mills Journal: J Acquir Immune Defic Syndr Date: 2017-09-01 Impact factor: 3.731