Adolescent and young pregnant women at increased risk of mother-to-child transmission of HIV and poorer maternal and infant health outcomes: A cohort study at public facilities in the Nelson Mandela Bay Metropolitan district, Eastern Cape, South Africa
Adolescent and young pregnant women at increased risk of mother-to-child transmission of HIV and poorer maternal and infant health outcomes: A cohort study at public facilities in the Nelson Mandela Bay Metropolitan district, Eastern Cape, South Africa
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DOI：
10.7196/samj.8207
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发表时间：
2014-12-01
期刊：
影响因子：
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通讯作者：
Grimwood, A
中科院分区：
文献类型：
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作者：
Fatti, G;Shaikh, N;Grimwood, A
背景资料。南非(SA)是全球儿童艾滋病毒感染负担最高的国家，青少年和青年怀孕率也很高。为了探讨年轻HIV感染妇女怀孕的相关风险，我们比较了HIV母婴传播(MTCT)和母婴健康结局与母亲年龄类别的关系。在南非东开普省纳尔逊·曼德拉湾区的三个哨兵监测设施对一群艾滋病毒阳性孕妇及其婴儿进行了跟踪调查。将青年女性定义为24岁，青少年定义为24岁为对照组。在956名母亲中，312名(32.6%)是年轻女性；其中65名(20.8%)是青少年。从2009/10年度到2011/12年度，年轻孕妇的比例增加了24%(从28.3%增加到35.1%)。年轻女性在登记时不知道自己的艾滋病毒状况的风险增加(调整后的风险比(ARR)1.37；95%可信区间(CI)1.21-1.54)，产前接受抗逆转录病毒治疗(ART)的比率降低(调整后的风险比0.46；95%的可信区间(CI)0.31-0.67)，婴儿早期艾滋病毒诊断减少(ARR为0.94；95%的可信区间为0.94-0.94)，母婴传播时间(MTCT)增加(ARR为3.07；95%的可信区间为1.18-7.96；根据抗逆转录病毒疗法的使用进行调整)。在所有垂直传播中，56%发生在年轻女性中。此外，青少年在分娩过程中首次出现的风险(ARR 3.78；95%可信区间1.06-13.4)、孕产妇死亡率(ARR 35.1；95%可信区间2.89-426)和死产风险(ARR 3.33；95%可信区间1.53-7.25)增加。在NMBM中，越来越多的艾滋病毒阳性孕妇是年轻的，她们的母婴传播率较高，孕产妇和婴儿的结局比老年妇女差。如果南非要实现其千年发展目标，就越来越需要针对年轻妇女的干预措施，以减少怀孕、艾滋病毒感染和母婴传播，并改善母婴结局。
Background. South Africa (SA) has the highest burden of childhood HIV infection globally, and has high rates of adolescent and youth pregnancy.Objective. To explore risks associated with pregnancy in young HIV-infected women, we compared mother-to-child transmission (MTCT) of HIV and maternal and infant health outcomes according to maternal age categories.Methods. A cohort of HIV-positive pregnant women and their infants were followed up at three sentinel surveillance facilities in the Nelson Mandela Bay Metropolitan (NMBM) district, Eastern Cape Province, SA. Young women were defined as years old and adolescents as 24 years as the comparison group.Results. Of 956 mothers, 312 (32.6%) were young women; of these, 65 (20.8%) were adolescents. The proportion of young pregnant women increased by 24% between 2009/10 and 2011/12 (from 28.3% to 35.1%). Young women had an increased risk of being unaware of their HIV status when booking (adjusted risk ratio (aRR) 1.37; 95% confidence interval (Cl) 1.21 - 1.54), a reduced rate of antenatal antiretroviral therapy (ART) uptake (adjusted hazard ratio 0.46; 95% CI 0.31 - 0.67), reduced early infant HIV diagnosis (aRR 0.94; 95% CI 0.94 - 0.94), and increased MTCT (aRR 3.07; 95% Cl 1.18 - 7.96; adjusted for ART use). Of all vertical transmissions, 56% occurred among young women. Additionally, adolescents had increased risks of first presentation during labour (aRR 3.78; 95% CI 1.06 - 13.4); maternal mortality (aRR 35.1; 95% CI 2.89 - 426) and stillbirth (aRR 3.33; 95% Cl 1.53 - 7.25).Conclusion. An increasing proportion of pregnant HIV-positive women in NMBM were young, and they had increased MTCT and poorer maternal and infant outcomes than older women. Interventions targeting young women are increasingly needed to reduce pregnancy, HIV infection and MTCT and improve maternal and infant outcomes if SA is to attain its Millennium Development Goals.