Hospitalizations of Pregnant HIV-Infected Women in the USA Prior to and During the Era of HAART, 1994-2003

In noting that "the literature on whether HIV infection and its complex antiretroviral treatments confer a higher risk for adverse pregnancy outcomes is controversial," the authors of the current study set out to compare rates of hospitalization for select morbidities among HIV-infected and uninfected pregnant women in the United States.

Data from the 1994-2003 Nationwide Inpatient Sample were employed. Descriptive statistics and multivariate logistic regression were used to examine socio-demographic characteristics, morbidity outcomes and time trends.

Annually, there were approximately 6,000 hospitalizations of HIV-infected pregnant women. HIV-positive women were more likely to be hospitalized in urban hospitals, in the South, have Medicaid as the expected payer, have longer hospitalizations and incur higher charges than uninfected women. Compared to their uninfected counterparts, pregnant HIV-infected women were more frequently hospitalized for major puerperal sepsis, genitourinary infections, influenza, bacterial infections, preterm labor/delivery and liver disorders. However, there was no significant difference in rates of pre-eclampsia and antepartum hemorrhage between the two groups. Though rates of inpatient mortality and various infectious conditions decreased from 1994 to 2003, the rate of gestational diabetes among HIV-positive pregnant women increased.

"HIV-infected pregnant women in the USA continue to be at higher risk for morbidity and adverse obstetric outcomes," the authors concluded. "With the introduction of antiretroviral therapy, rates of most of the conditions examined have either decreased or remained stable, hence current antiretroviral regimens do not seem to be associated with major adverse pregnancy outcomes on a population basis. The increase in gestational diabetes among HIV-infected women may be associated, in part, with antiretroviral therapy and merits further attention."

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