PREMATURITY IN HIV-INFECTED WOMEN

In the Swiss Study ''HIV and pregnancy'' we observed 153 singleton pregnancies of HIV-positive women. 23 (15%) of those ended with a premature delivery. For drug addicts (n=100), the incidence of prematurity, 20%, significantly higher than in those free of drugs (n=53) with 5.6%. The most frequent cause of prematurity was premature labor or rupture of the membranes (n=13), followed by maternal illness (n=8) and fetal complications (n=2). Women with premature delivery tended to have lower CD4 cell counts than those with term delivery (29.4% vs 12.0% with <200 CD4 cells/mu l). Low CD4 cell counts and drug consumption are two independent but cumulative risks for severe infections. 16 of the 153 women (12 with, 4 without drug consumption) had severe infections during pregnancy; in 4 cases (25%), this led to prematurity. The most common infection was pneumonia (14/16). further one case of pyelonephritis and one of cerebral toxoplasmosis. Two of these 16 infants (12.5%) were HIV-positive. We could not confirm a relationship between prematurity and vertical HIV transmission. Of the HIV-classified children, 3/18 (16.7%) premature infants and 16/74 (21.6%) term infants were infected.