Risa M Hoffman1, Caitlin Newhouse2, Brian Chu3, Jeffrey S A Stringer4, Judith S Currier5. 1. Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave 37-121 CHS, Los Angeles, CA, 90095, USA. rhoffman@mednet.ucla.edu. 2. Preventive Medicine Program, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA. 3. David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA. 4. Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA. 5. Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave 37-121 CHS, Los Angeles, CA, 90095, USA.
Abstract
PURPOSE OF REVIEW: The development of non-communicable diseases (NCDs) in pregnant women living with HIV can be a harbinger of future NCD-related morbidity and mortality. This review focuses on the NCDs that complicate pregnancy and the postpartum period, including hypertensive complications, hyperglycemic disorders, excessive gestational weight gain, and bone mineral density losses. For each disease process, we explore the role of HIV as a possible driver of excess risk, the immediate consequences of these complications on pregnancy outcomes and maternal and infant health, and possible implications for long-term women's health. RECENT FINDINGS: Countries with the highest burden of HIV also shoulder a high burden of NCDs that complicate pregnancy, including hypertensive disorders, hyperglycemic disorders, weight gain, and osteopenia. This double burden of disease is a significant public health threat for reproductive-age women, with the potential for serious short- and long-term consequences for both women and their infants. Additionally, as the global first-line antiretroviral therapy regimens increasingly include integrase inhibitors, unhealthy weight gain associated with this drug class poses additional risk for NCD-related pregnancy complications and their persistence postpartum. Further research is needed to better define prevalence of NCD complications in pregnancy, elucidate HIV-specific and traditional factors associated with poor outcomes, and to develop interventions to reduce risk and avoid downstream complications in those at highest risk.
PURPOSE OF REVIEW: The development of non-communicable diseases (NCDs) in pregnant women living with HIV can be a harbinger of future NCD-related morbidity and mortality. This review focuses on the NCDs that complicate pregnancy and the postpartum period, including hypertensive complications, hyperglycemic disorders, excessive gestational weight gain, and bone mineral density losses. For each disease process, we explore the role of HIV as a possible driver of excess risk, the immediate consequences of these complications on pregnancy outcomes and maternal and infant health, and possible implications for long-term women's health. RECENT FINDINGS: Countries with the highest burden of HIV also shoulder a high burden of NCDs that complicate pregnancy, including hypertensive disorders, hyperglycemic disorders, weight gain, and osteopenia. This double burden of disease is a significant public health threat for reproductive-age women, with the potential for serious short- and long-term consequences for both women and their infants. Additionally, as the global first-line antiretroviral therapy regimens increasingly include integrase inhibitors, unhealthy weight gain associated with this drug class poses additional risk for NCD-related pregnancy complications and their persistence postpartum. Further research is needed to better define prevalence of NCD complications in pregnancy, elucidate HIV-specific and traditional factors associated with poor outcomes, and to develop interventions to reduce risk and avoid downstream complications in those at highest risk.
Authors: Michele K Saums; Caroline C King; Jenna C Adams; Anandi N Sheth; Martina L Badell; Marisa Young; Lynn M Yee; Ellen G Chadwick; Denise J Jamieson; Lisa B Haddad Journal: Obstet Gynecol Date: 2019-12 Impact factor: 7.661
Authors: Joyce L Browne; Verena J M M Schrier; Diederick E Grobbee; Sanne A E Peters; Kerstin Klipstein-Grobusch Journal: J Acquir Immune Defic Syndr Date: 2015-09-01 Impact factor: 3.731
Authors: Marie C D Stoner; Bellington Vwalika; Marcela C Smid; Shalin George; Benjamin H Chi; Elizabeth M Stringer; Jeffrey S A Stringer Journal: Int J Gynaecol Obstet Date: 2016-05-25 Impact factor: 3.561