Abstract

Evaluation of prematurity among HIV infected and non-infected women in Rio de Janeiro, Brazil

T.P. Costa¹, M.D.C. Leal², C. Jurema², E. Machado³, R.H. Oliveira¹, C.B. Hofer<sup>4

1</sup>Universidade Federal do Rio de Janeiro, Pediatrics, Rio de Janeiro, Brazil, ²Escola Nacional de Saúde Pública/FIOCRUZ, Epidemiology, Rio de Janeiro, Brazil, ³Universidade Federal do Rio de Janeiro, Infectious Diseases, Rio de Janeiro, Brazil, ⁴Universidade de Federal do Rio de Janeiro, Preventive Medicine - Infectious Diseases, Rio de Janeiro, Brazil

Background: HIV status of the pregnant women, treatments, and pregnancy outcomes. The aim of this study is to evaluate intervening variables in the occurrence of prematurity in pregnant women infected or not with HIV.
Methods: It is an unmatched case-control study (3 controls per case). Cases were derived from a prospective cohort study of all HIV-infected pregnant women followed from 1995 to 2005, in a reference center in Rio de Janeiro. Controls were derived from a random sample of all pregnant women who gave birth at Rio de Janeiro Municipality between 1999 and 2001.
All relevant socio-demographic, nosological, and pregnancy outcomes data were retrieved from both cohort studies. To evaluate the prenatal care, we calculated the Kotelchuck modified index, it measures the concentration of prenatal visits during the care period, according to gestational age at birth. Comparisons were performed using Student t- and Chi-square test. Variables with p-value< 0.25 were included in a logistic regression model.
Results: There were 713 cases and 2145 controls. Variables associated with prematurity, controlling for cases and controls were less than 8 years of education (OR=1,35, 95%CI=1,07-1,70); hypertension (OR=1,54, 95%CI=1,06-2,26), more pregnancies (OR=1,10, 95%, CI=1,02-1,19), and inadequate Kotelchuck modified index (OR=1.59, 95%CI=1.40-1.78).
Conclusions: In conclusion, education, - hypertension, more pregnancies, and inadequate number of prenatal care visits were associated with prematurity, even adjusting for HIV status. Although in Brazil, the HIV care is free of charge, pregnant women are still reaching late the specialized care, with consequently higher rates of prematurity. Better access to care must be offered to this population, and studies of prematurity in the HIV infected women must evaluate how late these women reach their care.