h Ultrasound examination, fetal echocardiography and prenatal outcome in HIV-positive pregnant women under antiretroviral therapy

Purpose: to evaluate fetal structural and/or functional abnormalities by ultrasound examination and fetal echocardiography, in pregnant women positive for human immunodeficiency virus (HIV). Methods: we analyzed prospectively 109 HIV positive pregnant women under antiretroviral therapy (Study Group) and 200 low risk pregnant patients (Control Group). All of them were submitted to ultrasound scan and fetal and neonatal echocardiography once a month. The amniotic fluid volume, fetal growth, fetal structural and functional alteration and the perinatal outcome were evaluated. Results: there were eight (7.3%) cases of fetal structural abnormality in the Study Group and two (1%) in the Control Group (p=0.616). There were four cases of congenital heart disease and four cases of hydronephrosis in the Study Group, with statistic significance (p=0.015) for the cardiac abnormalities. There were eight cases (7.3%) of oligohydramnios and 11 cases (10%) of polyhydramnios in the Study Group against two cases (1%) of oligohydramnios and none of polyhydramnios in the Control Group (p=0.004 and p< 0.001). Eleven (10%) newborn babies were too small for their gestation age in the Study Group, against three (2.7%) in the Control Group (p=0,002). The incidence of preterm delivery was 8.7 and 2.5% in the Study and Control Groups respectively (p=0.041). It was observed six cases (5.5%) of fetal death in the Study Group and none in the Control Group (p=0.002). Conclusions: in the present study, we have observed higher prevalence of amniotic fluid volume and congenital heart abnormalities in the Study Group as compared to the Control Group. Statistical significance was found in both situations. The high fetal death rate found in the Study Group was probably due to fetal malformation, whereas the high prematurity rate and the prevalence of small size for the gestational age of the newborn babies were probably related to antiretroviral therapy, smoking and drug abuse.