Maternal and neonatal outcomes among women with HIV infection and their infants in Malawi

Int J Gynaecol Obstet. 2017 Jun;137(3):282-289. doi: 10.1002/ijgo.12136. Epub 2017 Mar 29.


Objective: To describe maternal and neonatal morbidity and mortality among women with HIV infection and their infants.

Methods: A secondary analysis was undertaken of data obtained in the BAN Study, a trial of postnatal antiretrovirals among pregnant women with HIV infection enrolled in 2004-2010. Mothers and infants had 13 scheduled visits through 48 weeks of follow-up. Serious maternal morbidity and mortality were examined at delivery (n=2791), from delivery to 6 weeks later (n=2369) and from 7 to 48 weeks (n=1980). Neonatal morbidity and mortality were examined (n=2685).

Results: Of 2791 deliveries, 169 (6.1%) were by cesarean (153 emergency). Compared with women with vaginal delivery, those with cesarean delivery had lower prenatal HIV viral loads (P=0.016) and increased odds of pre-eclampsia/eclampsia (odds ratio [OR] 10.8, 95% CI 4.4-26.8). Women with cesarean delivery also had increased odds of serious infection with 14 days of delivery (OR 3.0, 95% CI 1.3-7.4) and severe anemia (grade 3 or 4) by 6 weeks (OR 6.7, 95% CI 2.3-19.1). Infants born by cesarean had increased odds of a low 5-minute Apgar score (OR 8.1, 95% CI 3.5-18.6) and admission to an intensive care unit (OR 5.4, 95% CI 3.7-7.8).

Conclusion: Odds of serious maternal and neonatal morbidity were higher after cesarean than vaginal delivery, despite lower maternal viral loads.

Keywords: HIV; Cesarean delivery; Malawi; Maternal morbidity; Mortality; Neonatal morbidity.

MeSH terms

  • Adult
  • Delivery, Obstetric / statistics & numerical data*
  • Female
  • HIV Infections / epidemiology*
  • Humans
  • Infant
  • Infant Mortality
  • Infant, Newborn
  • Malawi / epidemiology
  • Maternal Mortality
  • Morbidity
  • Perinatal Mortality
  • Pregnancy
  • Pregnancy Complications, Infectious / epidemiology*
  • Pregnancy Outcome / epidemiology*
  • Young Adult