@article {10575, title = {Rate, correlates and outcomes of repeat pregnancy in HIV-infected women.}, journal = {HIV Med}, volume = {18}, year = {2017}, month = {2017 07}, pages = {440-443}, abstract = {

OBJECTIVES: The aim of the study was to assess the rate, determinants, and outcomes of repeat pregnancies in women with HIV infection.

METHODS: Data from a national study of pregnant women with HIV infection were used. Main outcomes were preterm delivery, low birth weight, CD4 cell count and HIV plasma viral load.

RESULTS: The rate of repeat pregnancy among 3007 women was 16.2\%. Women with a repeat pregnancy were on average younger than those with a single pregnancy (median age 30 vs. 33 years, respectively), more recently diagnosed with HIV infection (median time since diagnosis 25 vs. 51 months, respectively), and more frequently of foreign origin [odds ratio (OR) 1.36; 95\% confidence interval (CI) 1.10-1.68], diagnosed with HIV infection in the current pregnancy (OR: 1.69; 95\% CI: 1.35-2.11), and at their first pregnancy (OR: 1.33; 95\% CI: 1.06-1.66). In women with sequential pregnancies, compared with the first pregnancy, several outcomes showed a significant improvement in the second pregnancy, with a higher rate of antiretroviral treatment at conception (39.0 vs. 65.4\%, respectively), better median maternal weight at the start of pregnancy (60 vs. 61 kg, respectively), a higher rate of end-of-pregnancy undetectable HIV RNA (60.7 vs. 71.6\%, respectively), a higher median birth weight (2815 vs. 2885 g, respectively), lower rates of preterm delivery (23.0 vs. 17.7\%, respectively) and of low birth weight (23.4 vs. 15.4\%, respectively), and a higher median CD4 cell count (+47 cells/μL), with almost no clinical progression to Centers for Disease Control and Prevention stage C (CDC-C) HIV disease (0.3\%). The second pregnancy was significantly more likely to end in voluntary termination than the first pregnancy (11.4 vs. 6.1\%, respectively).

CONCLUSIONS: Younger and foreign women were more likely to have a repeat pregnancy; in women with sequential pregnancies, the second pregnancy was characterized by a significant improvement in several outcomes, suggesting that women with HIV infection who desire multiple children may proceed safely and confidently with subsequent pregnancies.

}, keywords = {Adult, Anti-HIV Agents, CD4 Lymphocyte Count, Emigrants and Immigrants, Female, HIV Infections, HIV-1, Humans, Infant, Low Birth Weight, Pregnancy, Premature Birth, Viral Load}, issn = {1468-1293}, doi = {10.1111/hiv.12473}, author = {Floridia, M and Tamburrini, E and Masuelli, G and Martinelli, P and Spinillo, A and Liuzzi, G and Vimercati, A and Alberico, S and Maccabruni, A 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} }