@article {8506, title = {Amniocentesis and chorionic villus sampling in HIV-infected pregnant women: a multicentre case series.}, journal = {BJOG}, volume = {124}, year = {2017}, month = {2017 Jul}, pages = {1218-1223}, abstract = {

OBJECTIVES: To assess in pregnant women with HIV the rates of amniocentesis and chorionic villus sampling (CVS), and the outcomes associated with such procedures.

DESIGN: Observational study. Data from the Italian National Program on Surveillance on Antiretroviral Treatment in Pregnancy were used.

SETTING: University and hospital clinics.

POPULATION: Pregnant women with HIV.

METHODS: Temporal trends were analysed by analysis of variance and by the Chi-square test for trend. Quantitative variables were compared by Student{\textquoteright}s t-test and categorical data by the Chi-square test, with odds ratios and 95\% confidence intervals calculated.

MAIN OUTCOME MEASURES: Rate of invasive testing, intrauterine death, HIV transmission.

RESULTS: Between 2001 and 2015, among 2065 pregnancies in women with HIV, 113 (5.5\%) had invasive tests performed. The procedures were conducted under antiretroviral treatment in 99 cases (87.6\%), with a significant increase over time in the proportion of tests performed under highly active antiretroviral therapy (HAART) (100\% in 2011-2015). Three intrauterine deaths were observed (2.6\%), and 14 pregnancies were terminated because of fetal anomalies. Among 96 live newborns, eight had no information available on HIV status. Among the remaining 88 cases with either amniocentesis (n = 75), CVS (n = 12), or both (n = 1), two HIV transmissions occurred (2.3\%). No HIV transmission occurred among the women who were on HAART at the time of invasive testing, and none after 2005.

CONCLUSIONS: The findings reinforce the assumption that invasive prenatal testing does not increase the risk of HIV vertical transmission among pregnant women under suppressive antiretroviral treatment.

TWEETABLE ABSTRACT: No HIV transmission occurred among women who underwent amniocentesis or CVS under effective anti-HIV regimens.

}, keywords = {Adult, Amniocentesis, Analysis of Variance, Anti-Retroviral Agents, Chi-Square Distribution, Chorionic Villi Sampling, Female, Fetal Death, HIV Infections, Humans, Infectious Disease Transmission, Vertical, Odds Ratio, Pregnancy, Pregnancy Complications, Infectious}, issn = {1471-0528}, doi = {10.1111/1471-0528.14183}, author = {Floridia, M and Masuelli, G and Meloni, A and Cetin, I and Tamburrini, E and Cavaliere, A F and Dalzero, S and Sansone, M and Alberico, S and Guerra, B and Spinillo, A and Chiad{\`o} Fiorio Tin, M and Ravizza, M} } @article {10507, title = {Pregnant with HIV before age 25: data from a large national study in Italy, 2001-2016.}, journal = {Epidemiol Infect}, volume = {145}, year = {2017}, month = {2017 08}, pages = {2360-2365}, abstract = {

Young pregnant women with HIV may be at significant risk of unplanned pregnancy, lower treatment coverage, and other adverse pregnancy outcomes. In a large cohort of pregnant women with HIV in Italy, among 2979 pregnancies followed in 2001-2016, 9{\textperiodcentered}0\% were in women <25 years, with a significant increase over time (2001-2005: 7{\textperiodcentered}0\%; 2006-2010: 9{\textperiodcentered}1\%; 2011-2016: 12{\textperiodcentered}2\%, P < 0{\textperiodcentered}001). Younger women had a lower rate of planned pregnancy (23{\textperiodcentered}2\% vs. 37{\textperiodcentered}7\%, odds ratio (OR) 0{\textperiodcentered}50, 95\% confidence interval (CI) 0{\textperiodcentered}36-0{\textperiodcentered}69), were more frequently diagnosed with HIV in pregnancy (46{\textperiodcentered}5\% vs. 20{\textperiodcentered}9\%, OR 3{\textperiodcentered}29, 95\% CI 2{\textperiodcentered}54-4{\textperiodcentered}25), and, if already diagnosed with HIV before pregnancy, were less frequently on antiretroviral treatment at conception (<25 years: 56{\textperiodcentered}3\%; ⩾25 years: 69{\textperiodcentered}0\%, OR 0{\textperiodcentered}58, 95\% CI 0{\textperiodcentered}41-0{\textperiodcentered}81). During pregnancy, treatment coverage was almost universal in both age groups (98{\textperiodcentered}5\% vs. 99{\textperiodcentered}3\%), with no differences in rate of HIV viral suppression at third trimester and adverse pregnancy outcomes. The data show that young women represent a growing proportion of pregnant women with HIV, and are significantly more likely to have unplanned pregnancy, undiagnosed HIV infection, and lower treatment coverage at conception. During pregnancy, antiretroviral treatment, HIV suppression, and pregnancy outcomes are similar compared with older women. Earlier intervention strategies may provide additional benefits in the quality of care for women with HIV.

}, keywords = {Adolescent, Cohort Studies, Female, HIV Infections, Humans, Italy, Odds Ratio, Pregnancy, Young Adult}, issn = {1469-4409}, doi = {10.1017/S0950268817001340}, author = {Floridia, M and Masuelli, G and Tamburrini, E and Cetin, I and Liuzzi, G and Martinelli, P and Guaraldi, G and Spinillo, A and Vimercati, A and Maso, G and Pinnetti, C and Frisina, V and Dalzero, S and Ravizza, M} } @article {1832, title = {Relation between maternal thrombophilia and stillbirth according to causes/associated conditions of death.}, journal = {Early Hum Dev}, volume = {88}, year = {2012}, month = {2012 Apr}, pages = {251-4}, abstract = {

OBJECTIVE: To investigate maternal thrombophilia in cases of Stillbirth (SB), also an uncertain topic because most case series were not characterised for cause/associated conditions of death.

STUDY DESIGN: In a consecutive, prospective, multicentre design, maternal DNA was obtained in 171 cases of antenatal SB and 326 controls (uneventful pregnancy at term, 1:2 ratio). Diagnostic work-up of SB included obstetric history, neonatologist inspection, placenta histology, autopsy, microbiology/chromosome evaluations. Results audited in each centre were classified by two of us by using CoDAC. Cases were subdivided into explained SB where a cause of death was identified and although no defined cause was detected in the remnants, 64 cases found conditions associated with placenta-vascular disorders (including preeclampsia, growth restriction and placenta abruption - PVD). In the remnant 79 cases, no cause of death or associated condition was found. Antithrombin activity, Factor V Leiden, G20210A Prothrombin mutation (FII mutation) and acquired thrombophilia were analysed.

RESULTS: Overall, the presence of a thrombophilic defect was significantly more prevalent in mothers with SBs compared to controls. In particular, SB mothers showed an increased risk of carrying Factor II mutation (OR=3.2, 95\% CI: 1.3-8.3, p=0.01), namely in unexplained cases. Such mutation was significantly associated also with previous SB (OR=8.9, 95\%CI 1.2-70.5). At multiple logistic regression, Factor II mutation was the only significantly associated variable with SB (adj OR=3.8, 95\% CI: 1.3-13.5).

CONCLUSION: These data suggest that Factor II mutation is the only condition specifically associated with unexplained SB and could represents a risk of recurrence. PVD-associated condition is unrelated to thrombophilia.

}, keywords = {Adult, Case-Control Studies, Cause of Death, Female, Fetal Diseases, Fetal Mortality, Humans, Infant, Newborn, Male, Placenta Diseases, Pre-Eclampsia, Pregnancy, Pregnancy Complications, Hematologic, Socioeconomic Factors, Stillbirth, Thrombophilia, Young Adult}, issn = {1872-6232}, doi = {10.1016/j.earlhumdev.2011.08.013}, author = {Monari, F and Alberico, S and Avagliano, L and Cetin, I and Cozzolino, S and Gargano, G and Marozio, L and Mecacci, F and Neri, I and Tranquilli, A L and Venturini, P and Facchinetti, F} }