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Prenatal ultrasound screening and pregnancy outcomes in HIV-positive women in Germany: results from a retrospective single-center study at the Charité-Universitätsmedizin Berlin

  • Maternal-Fetal Medicine
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objectives

The aim of this study was to investigate the rate of Mother-to-child-transmission (MTCT) in women living with HIV (WLWH) in a tertiary care institution. Furthermore, we aimed to assess prenatal ultrasound screening for fetal anomalies and outcomes in high-risk pregnancies due to maternal HIV infection.”

Methods

In this single-center study, retrospective data related to pregnancy and childbirth were collected from 420 WLWH. All data were evaluated descriptively.

Results

From January 2014 to December 2020, a total number of 420 pregnant WLWH delivered 428 newborns. 415 (98.8%) were receiving antiretroviral therapy (ART) and 88.8% had a viral load of < 50 cop/ml prior delivery. 46 (11%) of the newborns were born prematurely. Low birth weight < 2500 g occurred in 38 (9.1%) of the children. 219 (52.1%) caesarean sections (CS) were performed. The most frequent indication for an elective CS was a previous CS (70.2%). 8 severe malformations were detected using first and second trimester ultrasound. In one child, MTCT was detected postpartum, resulting in an HIV transmission rate of 0.2% in the presented cohort.

Conclusions

The low rate of vertical HIV-transmission in our cohort of 0.2% is the result of interdisciplinary prenatal care and high experience of healthcare providers in treatment of WLWH. Despite high ART coverage and adherence, good maternal immune system and very low vertical HIV transmission rate, maternal HIV infection remains a challenge in obstetric care. First and second ultrasound screening should be a part of prenatal care for HIV-infected women and should also be offered to HIV-negative women. A reduction of the rate of unnecessary elective caesarean deliveries in WLWH is necessary to reduce complications in subsequent pregnancies.

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References

  1. Action plan for the health sector response to HIV in the WHO European Region. In. Copenhagen: World Health Organization Regional Office for Europe (2016). https://www.euro.who.int/__data/assets/pdf_file/0010/315649/66wd09e_HIVActionPlan_160560.pdf (Last accessed on 13.09.2022)

  2. Marcus U (2019) HIV infections and HIV testing during pregnancy, Germany, 1993 to 2016. Euro Surveill. https://doi.org/10.2807/1560-7917.ES.2019.24.48.1900078

    Article  PubMed  PubMed Central  Google Scholar 

  3. Richtlinien des Gemeinsamen Bundesausschusses über die ärztliche Betreuung während der Schwangerschaft und nach der Entbindung („Mutterschafts-Richtlinien“) In: Bundesanzeiger (1985). https://www.g-ba.de/downloads/62-492-2676/Mu-RL_2021-09-16_iK-2022-01-01.pdf (Last accessed on 13.09.2022)

  4. Siegfried N, van der Merwe L, Brocklehurst P, Sint TT (2011) Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003510.pub3

    Article  PubMed  Google Scholar 

  5. Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Transmission in the United States. In: HHS Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission - A Working Group of the Office of AIDS Research Advisory Council (OARAC) (2021). https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/Perinatal_GL.pdf (Last accessed on 13.09.2022)

  6. Connor EM, Sperling RS, Gelber R, Kiselev P, Scott G, Sullivan MJ, Pediatric AIDS Clinical Trials Group Protocol 076 Study Group et al (1994) Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med 331(18):1173–1180

    Article  CAS  PubMed  Google Scholar 

  7. Townsend CL, Byrne L, Cortina-Borja M, Thorne C, de Ruiter A, Lyall H et al (2014) Earlier initiation of ART and further decline in mother-to-child HIV transmission rates, 2000–2011. AIDS 28(7):1049–1057

    Article  PubMed  Google Scholar 

  8. Volmink J, Marais B (2008) HIV: mother-to-child transmission. BMJ Clin Evid 2008:0909

    PubMed  PubMed Central  Google Scholar 

  9. Kind C, Rudin C, Siegrist CA, Wyler CA, Biedermann K, Lauper U et al (1998) Prevention of vertical HIV transmission: additive protective effect of elective Cesarean section and zidovudine prophylaxis. Swiss Neonatal HIV Study Group Aids 12(2):205–210

    CAS  Google Scholar 

  10. Kennedy CE, Yeh PT, Pandey S, Betran AP, Narasimhan M (2017) Elective cesarean section for women living with HIV: a systematic review of risks and benefits. AIDS 31(11):1579–1591

    Article  PubMed  Google Scholar 

  11. Daig (2020) Deutsch-Österreichische Leitlinien zur antiretroviralen Therapie der HIV-1-Infektion

  12. Read JS, Newell MK (2005) Efficacy and safety of cesarean delivery for prevention of mother-to-child transmission of HIV-1. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005479

    Article  PubMed  Google Scholar 

  13. Semprini AE, Castagna C, Ravizza M, Fiore S, Savasi V, Muggiasca ML et al (1995) The incidence of complications after caesarean section in 156 HIV-positive women. AIDS 9(8):913–917

    Article  CAS  PubMed  Google Scholar 

  14. Lapaire O, Irion O, Koch-Holch A, Holzgreve W, Rudin C, Hoesli I (2006) Increased peri- and post-elective cesarean section morbidity in women infected with human immunodeficiency virus-1: a case-controlled multicenter study. Arch Gynecol Obstet 274(3):165–169

    Article  PubMed  Google Scholar 

  15. Robson MS (2001) Classification of caesarean sections. Fetal Matern Med Rev 12(1):23–39

    Article  Google Scholar 

  16. WHO (2017) ROBSON Classification: Implementation Manual. In. Geneva: World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/259512/9789241513197-eng.pdf?sequence=1 (Last accessed on 13.09.2022)

  17. Robson MS (2001) Can we reduce the caesarean section rate? Best Pract Res Clin Obstet Gynaecol 15(1):179–194

    Article  CAS  PubMed  Google Scholar 

  18. Robson MS, Hartigan L, Murphy M (2013) Methods of achieving and maintaining an appropriate caesarean section rate. Best Pract Res Clin Obstet Gynaecol 27(2):297–308

    Article  PubMed  Google Scholar 

  19. Veroniki AA, Antony J, Straus SE, Ashoor HM, Finkelstein Y, Khan PA et al (2018) Comparative safety and effectiveness of perinatal antiretroviral therapies for HIV-infected women and their children: systematic review and network meta-analysis including different study designs. PLoS ONE 13(6):e0198447

    Article  PubMed  Google Scholar 

  20. Wedi CO, Kirtley S, Hopewell S, Corrigan R, Kennedy SH, Hemelaar J (2016) Perinatal outcomes associated with maternal HIV infection: a systematic review and meta-analysis. Lancet HIV 3(1):e33-48

    Article  PubMed  Google Scholar 

  21. Shinar S, Agrawal S, Ryu M, Walmsley S, Serghides L, Yudin MH et al (2022) Perinatal outcomes in women living with HIV-1 and receiving antiretroviral therapy-a systematic review and meta-analysis. Acta Obstet Gynecol Scand 101(2):168–182

    Article  PubMed  Google Scholar 

  22. Xiao PL, Zhou YB, Chen Y, Yang MX, Song XX, Shi Y et al (2015) Association between maternal HIV infection and low birth weight and prematurity: a meta-analysis of cohort studies. BMC Pregnancy Childbirth 15:246

    Article  PubMed  PubMed Central  Google Scholar 

  23. Aberg JA, Kaplan JE, Libman H, Emmanuel P, Anderson JR, Stone VE et al (2009) Primary care guidelines for the management of persons infected with human immunodeficiency virus: 2009 update by the HIV medicine association of the infectious diseases society of America. Clin Infect Dis 49(5):651–681

    Article  PubMed  Google Scholar 

  24. Schneider E, Whitmore S, Glynn KM, Dominguez K, Mitsch A, McKenna MT, Centers for Disease Control and Prevention (CDC) (2008) Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years—United States, 2008. MMWR Recomm Rep 57(RR-10):1–12

    PubMed  Google Scholar 

  25. Read JS (2007) Diagnosis of HIV-1 infection in children younger than 18 months in the United States. Pediatrics 120(6):e1547-1562

    Article  PubMed  Google Scholar 

  26. Chadwick EG, Ezeanolue EE (2020) Evaluation and management of the infant exposed to HIV in the United States. Pediatrics. https://doi.org/10.1542/peds.2020-029058

    Article  PubMed  Google Scholar 

  27. Pitzen IC, Otten LA, Dresbach T, Boesecke C, Wasmuth JC, Mueller A et al (2019) Treatment of HIV in pregnancy-progress over one decade. Z Geburtshilfe Neonatol 223(1):26–32

    PubMed  Google Scholar 

  28. Neubert J, Pfeffer M, Borkhardt A, Niehues T, Adams O, Bolten M et al (2013) Risk adapted transmission prophylaxis to prevent vertical HIV-1 transmission: effectiveness and safety of an abbreviated regimen of postnatal oral zidovudine. BMC Pregnancy Childbirth 13:22

    Article  PubMed  PubMed Central  Google Scholar 

  29. Reitter A, Stücker AU, Buxmann H, Herrmann E, Haberl AE, Schlößer R et al (2013) Prenatal ultrasound screening for fetal anomalies and outcomes in high-risk pregnancies due to maternal HIV infection: a retrospective study. Infect Dis Obstet Gynecol 2013:208482

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Daig, Öaig, Dggg, Dgkj, Dgi, Gfv, et al (2020) Deutsch-Österreichische Leitlinie zur HIV-Therapie in der Schwangerschaft und bei HIV-exponierten Neugeborenen (Stand September 2020). In. AWMF online: Deutsche AIDS-Gesellschaft. https://www.awmf.org/uploads/tx_szleitlinien/055-002l_S2k_HIV-Therapie-Schwangerschaft-und-HIV-exponierten_Neugeborenen_2020-10_01.pdf (Last accessed on 13.09.2022)

  31. Ford N, Mofenson L, Kranzer K, Medu L, Frigati L, Mills EJ et al (2010) Safety of efavirenz in first-trimester of pregnancy: a systematic review and meta-analysis of outcomes from observational cohorts. AIDS 24(10):1461–1470

    Article  CAS  PubMed  Google Scholar 

  32. IQTIG (2016) Bundesauswertung zum Erfassungsjahr 2015 Geburtshilfe Qualitätsindikatoren. https://iqtig.org/downloads/auswertung/2015/16n1gebh/QSKH_16n1-GEBH_2015_BUAW_V02_2016-07-07.pdf (Last accessed on 17.08.2022)

  33. IQTIG (2021) Bundesauswertung zum Erfassungsjahr 2020 Geburtshilfe Qualitätsindikatoren. https://iqtig.org/downloads/auswertung/2020/16n1gebh/QSKH_16n1-GEBH_2020_BUAW_V01_2021-08-10.pdf (Last accessed on 17.08.2022)

  34. Altfeld M, Bunders MJ (2016) Impact of HIV-1 infection on the feto-maternal crosstalk and consequences for pregnancy outcome and infant health. Semin Immunopathol 38(6):727–738

    Article  PubMed  Google Scholar 

  35. IQTIG (2017) Bundesauswertung zum Erfassungsjahr 2016 Geburtshilfe Qualitätsindikatoren. https://iqtig.org/downloads/auswertung/2016/16n1gebh/QSKH_16n1-GEBH_2016_BUAW_V02_2017-07-12.pdf (Last accessed on 17.08.2022)

  36. Reitter A, Stücker AU, Linde R, Königs C, Knecht G, Herrmann E et al (2014) Pregnancy complications in HIV-positive women: 11-year data from the Frankfurt HIV Cohort. HIV Med 15(9):525–536

    Article  CAS  PubMed  Google Scholar 

  37. Keag OE, Norman JE, Stock SJ (2018) Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: systematic review and meta-analysis. PLoS Med 15(1):e1002494

    PubMed  PubMed Central  Google Scholar 

  38. Tahseen S, Griffiths M (2010) Vaginal birth after two caesarean sections (VBAC-2)-a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections. BJOG 117(1):5–19

    Article  CAS  PubMed  Google Scholar 

  39. Ørbaek M, Thorsteinsson K, Helleberg M, Moseholm E, Katzenstein TL, Storgaard M et al (2017) Assessment of mode of delivery and predictors of emergency caesarean section among women living with HIV in a matched-pair setting with women from the general population in Denmark, 2002–2014. HIV Med 18(10):736–747

    Article  PubMed  Google Scholar 

  40. Gemeinsame Erklärung der Deutschen AIDS-Gesellschaft (DAIG), Osterreichischen AIDS-Gesellschaft (OAG), Kompetenznetzes HIV/AIDS sowie des Robert-Koch-Institutes Berlin (RKI), Deutschen Arbeitsgemeinschaft niederniedergelassener Arzte in der Versorgung von HIV-und AIDS-Patienten (DAGNA), Deutschen Gesellschaft für Kinderheilkunde und Jugendmedizin (DGKJ), Pädiatrischen Arbeitsgemeinschaft AIDS Deutschland (PAAD), Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Nationalen Referenzzentrums für Retroviren (NRZ) der Deutschen AIDS-Hilfe (DAH) (2009) Deutsch-Osterreichische Empfehlungen zur HIV-Therapie in der Schwangerschaft und bei HIV-exponierten Neugeborenen—Update 2008 [German-Austrian recommendations for HIV treatment during pregnancy and for newborns exposed to HIV—Update 2008]. Dtsch Med Wochenschr 134 (Suppl 1):S40–54. https://doi.org/10.1055/s-0028-1123974

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Author notes

  1. Maja Hofacker and Alexander Weichert have contributed equally to this study.

Authors and Affiliations

  1. Department of Obstetrics, Charité–Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, CVK Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Maja Hofacker, Katharina von Weizsäcker, Jan-Peter Siedentopf, Wolfgang Henrich & Irena Rohr

  2. Prenatal Diagnosis and Women’s Health Bergmannstrasse, Bergmannstraße 102, 10961, Berlin, Germany

    Alexander Weichert

  3. Department of Pediatrics, Charité–Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Cornelia Feiterna-Sperling

  4. Institute for Social Medicine, Charité–Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Epidemiology and Health Economic, Luisenstraße 57, 10117, Berlin, Germany

    Michaela Heinrich-Rohr

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Contributions

The first draft of the manuscript was written by MH. Project development, data analysis, data collection and manuscript editing were performed by MH, AW and IR. CF-S, KvW, J-PS and WH were responsible for project development. J-PS, CF-S, KvW and IR contributed by data collection. IR performed editing of the manuscript. MH-R performed data analysis. All authors checked and agreed to the final manuscript.

Corresponding author

Correspondence to Irena Rohr.

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The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was conducted according to the principles of the Declaration of Helsinki. An ethics approval was necessary and given from ethical committees in Berlin (Nr. EA4/139/21).

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All data were fully pseudonymized before analysis and publication.

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Hofacker, M., Weichert, A., Feiterna-Sperling, C. et al. Prenatal ultrasound screening and pregnancy outcomes in HIV-positive women in Germany: results from a retrospective single-center study at the Charité-Universitätsmedizin Berlin. Arch Gynecol Obstet (2023). https://doi.org/10.1007/s00404-023-07286-0

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