Management and outcomes of pregnancies among women with HIV in Oxford, UK, in 2008–2012

ObjectiveTo evaluate the management and outcomes of pregnancies among women with HIV infection.MethodsA retrospective cohort study was undertaken of pregnant women with HIV who delivered at one center in the UK in 2008–2012. Case notes were reviewed and detailed information extracted regarding obstetric and virological management.ResultsOverall, 61 pregnancies were included; 43% (26/60) were unplanned and 39% (22/57) booked late. HIV infection was diagnosed during pregnancy for 32% (19/60); 71% (12/17) were diagnosed after the first trimester. At booking, 47% of women (28/60) were not on treatment, all but one of whom commenced treatment, either for maternal reasons (CD4 count < 350 cells per mm3; 48% [13/27]) or prevention of mother-to-child-transmission (52% [14/27]). Viral load was high (> 50 copies per mL) at delivery for 13% of women (8/61). Delivery was by cesarean for 74% [45/61]. One neonate was diagnosed with HIV infection. There were 6 (10%) preterm births, 9 (15%) cases of low birth weight, 11 (18%) small-for-gestational-age neonates, and 1 (2%) stillbirth.ConclusionBetter pregnancy planning, earlier booking and HIV diagnosis, and optimal antiretroviral treatment should increase the proportion of women with a low viral load (< 50 copies per mL) at delivery, lead to more vaginal deliveries, and further reduce mother-to-child transmission of HIV.