Predictors of stillbirth among HIV-infected Tanzanian women
Identifieur interne : 000F67 ( Pmc/Corpus ); précédent : 000F66; suivant : 000F68Predictors of stillbirth among HIV-infected Tanzanian women
Auteurs : Roland Kupka ; Tarik Kassaye ; Elmar Saathoff ; Ellen Hertzmark ; Gernard I. Msamanga ; Wafaie W. FawziSource :
- Acta obstetricia et gynecologica Scandinavica [ 0001-6349 ] ; 2009.
Abstract
To determine maternal risk factors for stillbirth among pregnant HIV-infected women in sub-Saharan Africa.
Prospective cohort study nested within a micronutrient trial. At enrollment, maternal sociodemographic, obstetric, immunologic, clinical, and nutritional variables were measured. Women were followed through monthly clinic visits until delivery. Multivariate predictors of stillbirth were identified in Poisson regression models.
Antenatal clinic in a tertiary care hospital in urban Dar es Salaam, Tanzania.
Stillbirth (delivery of dead baby ≥ 28 weeks’ gestation), fresh stillbirth, and macerated stillbirth.
Among 1,017 singleton pregnancies, there were 49 stillbirths, yielding a stillbirth risk of 50.0 per 1,000 deliveries (95% Confidence Interval(CI) = 37.2, 65.6). Of stillbirths with known type, 53.7% were fresh and 46.3% macerated. In multivariate analyses, baseline measures of late ( ≥ 21 weeks’ gestation) study entry (Relative Risk (RR) = 2.13, 95% CI = 1.17, 3.87), CD3 count ≥ 1,179 cells/ml (RR = 2.15, 95% CI = 1.16, 4.01), stillbirth history (RR = 3.53, 95% CI = 1.30, 9.59), primiparity (RR = 3.65, 95% CI = 1.83, 7.29), and syphilis infection (RR = 2.06, 95% CI = 1.09, 3.88) predicted increased stillbirth risk. Late study entry, illiteracy, stillbirth history, primiparity, CD3 count ≥ 1,179 cells/ml, gonorrhea infection, and previous hospitalization predicted increased risk of fresh stillbirth, while living alone and syphilis infection predicted increased risk of macerated stillbirth.
Applying antenatal screening and preventive tools for the socioeconomic, obstetric, immunologic, and clinical risk factors identified may assist in reducing the high incidence of stillbirth among HIV-infected women in urban sub-Saharan Africa.
Url:
DOI: 10.1080/00016340902835901
PubMed: 19306132
PubMed Central: 2796303
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Predictors of stillbirth among HIV-infected Tanzanian women</title><author><name sortKey="Kupka, Roland" sort="Kupka, Roland" uniqKey="Kupka R" first="Roland" last="Kupka">Roland Kupka</name><affiliation><nlm:aff id="A1">Department of Nutrition, Harvard School of Public Health, Boston, MA, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A2">United Nations Children’s Fund, Regional Office for West and Central Africa, Dakar, Senegal</nlm:aff></affiliation></author><author><name sortKey="Kassaye, Tarik" sort="Kassaye, Tarik" uniqKey="Kassaye T" first="Tarik" last="Kassaye">Tarik Kassaye</name><affiliation><nlm:aff id="A3">Unaffiliated</nlm:aff></affiliation></author><author><name sortKey="Saathoff, Elmar" sort="Saathoff, Elmar" uniqKey="Saathoff E" first="Elmar" last="Saathoff">Elmar Saathoff</name><affiliation><nlm:aff id="A4">Department of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany</nlm:aff></affiliation></author><author><name sortKey="Hertzmark, Ellen" sort="Hertzmark, Ellen" uniqKey="Hertzmark E" first="Ellen" last="Hertzmark">Ellen Hertzmark</name><affiliation><nlm:aff id="A5">Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA</nlm:aff></affiliation></author><author><name sortKey="Msamanga, Gernard I" sort="Msamanga, Gernard I" uniqKey="Msamanga G" first="Gernard I." last="Msamanga">Gernard I. Msamanga</name><affiliation><nlm:aff id="A6">Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Fawzi, Wafaie W" sort="Fawzi, Wafaie W" uniqKey="Fawzi W" first="Wafaie W." last="Fawzi">Wafaie W. Fawzi</name><affiliation><nlm:aff id="A1">Department of Nutrition, Harvard School of Public Health, Boston, MA, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A5">Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">19306132</idno><idno type="pmc">2796303</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796303</idno><idno type="RBID">PMC:2796303</idno><idno type="doi">10.1080/00016340902835901</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">000F67</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000F67</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Predictors of stillbirth among HIV-infected Tanzanian women</title><author><name sortKey="Kupka, Roland" sort="Kupka, Roland" uniqKey="Kupka R" first="Roland" last="Kupka">Roland Kupka</name><affiliation><nlm:aff id="A1">Department of Nutrition, Harvard School of Public Health, Boston, MA, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A2">United Nations Children’s Fund, Regional Office for West and Central Africa, Dakar, Senegal</nlm:aff></affiliation></author><author><name sortKey="Kassaye, Tarik" sort="Kassaye, Tarik" uniqKey="Kassaye T" first="Tarik" last="Kassaye">Tarik Kassaye</name><affiliation><nlm:aff id="A3">Unaffiliated</nlm:aff></affiliation></author><author><name sortKey="Saathoff, Elmar" sort="Saathoff, Elmar" uniqKey="Saathoff E" first="Elmar" last="Saathoff">Elmar Saathoff</name><affiliation><nlm:aff id="A4">Department of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany</nlm:aff></affiliation></author><author><name sortKey="Hertzmark, Ellen" sort="Hertzmark, Ellen" uniqKey="Hertzmark E" first="Ellen" last="Hertzmark">Ellen Hertzmark</name><affiliation><nlm:aff id="A5">Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA</nlm:aff></affiliation></author><author><name sortKey="Msamanga, Gernard I" sort="Msamanga, Gernard I" uniqKey="Msamanga G" first="Gernard I." last="Msamanga">Gernard I. Msamanga</name><affiliation><nlm:aff id="A6">Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Fawzi, Wafaie W" sort="Fawzi, Wafaie W" uniqKey="Fawzi W" first="Wafaie W." last="Fawzi">Wafaie W. Fawzi</name><affiliation><nlm:aff id="A1">Department of Nutrition, Harvard School of Public Health, Boston, MA, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A5">Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA</nlm:aff></affiliation></author></analytic><series><title level="j">Acta obstetricia et gynecologica Scandinavica</title><idno type="ISSN">0001-6349</idno><idno type="eISSN">1600-0412</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title><p id="P1">To determine maternal risk factors for stillbirth among pregnant HIV-infected women in sub-Saharan Africa.</p></sec><sec id="S2"><title>Design</title><p id="P2">Prospective cohort study nested within a micronutrient trial. At enrollment, maternal sociodemographic, obstetric, immunologic, clinical, and nutritional variables were measured. Women were followed through monthly clinic visits until delivery. Multivariate predictors of stillbirth were identified in Poisson regression models.</p></sec><sec id="S3"><title>Setting</title><p id="P3">Antenatal clinic in a tertiary care hospital in urban Dar es Salaam, Tanzania.</p></sec><sec id="S4"><title>Population</title><p id="P4"><italic>N</italic> = 1,078 women enrolled between 12 and 27 weeks of gestation.</p></sec><sec id="S5"><title>Main outcome measures</title><p id="P5">Stillbirth (delivery of dead baby ≥ 28 weeks’ gestation), fresh stillbirth, and macerated stillbirth.</p></sec><sec id="S6"><title>Results</title><p id="P6">Among 1,017 singleton pregnancies, there were 49 stillbirths, yielding a stillbirth risk of 50.0 per 1,000 deliveries (95% Confidence Interval(CI) = 37.2, 65.6). Of stillbirths with known type, 53.7% were fresh and 46.3% macerated. In multivariate analyses, baseline measures of late ( ≥ 21 weeks’ gestation) study entry (Relative Risk (RR) = 2.13, 95% CI = 1.17, 3.87), CD3 count ≥ 1,179 cells/ml (RR = 2.15, 95% CI = 1.16, 4.01), stillbirth history (RR = 3.53, 95% CI = 1.30, 9.59), primiparity (RR = 3.65, 95% CI = 1.83, 7.29), and syphilis infection (RR = 2.06, 95% CI = 1.09, 3.88) predicted increased stillbirth risk. Late study entry, illiteracy, stillbirth history, primiparity, CD3 count ≥ 1,179 cells/ml, gonorrhea infection, and previous hospitalization predicted increased risk of fresh stillbirth, while living alone and syphilis infection predicted increased risk of macerated stillbirth.</p></sec><sec id="S7"><title>Conclusions</title><p id="P7">Applying antenatal screening and preventive tools for the socioeconomic, obstetric, immunologic, and clinical risk factors identified may assist in reducing the high incidence of stillbirth among HIV-infected women in urban sub-Saharan Africa.</p></sec></div></front></TEI><pmc article-type="research-article" xml:lang="EN"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">0370343</journal-id><journal-id journal-id-type="pubmed-jr-id">139</journal-id><journal-id journal-id-type="nlm-ta">Acta Obstet Gynecol Scand</journal-id><journal-title>Acta obstetricia et gynecologica Scandinavica</journal-title><issn pub-type="ppub">0001-6349</issn><issn pub-type="epub">1600-0412</issn></journal-meta><article-meta><article-id pub-id-type="pmid">19306132</article-id><article-id pub-id-type="pmc">2796303</article-id><article-id pub-id-type="doi">10.1080/00016340902835901</article-id><article-id pub-id-type="manuscript">NIHMS147168</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Predictors of stillbirth among HIV-infected Tanzanian women</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kupka</surname><given-names>Roland</given-names></name><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Kassaye</surname><given-names>Tarik</given-names></name><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Saathoff</surname><given-names>Elmar</given-names></name><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Hertzmark</surname><given-names>Ellen</given-names></name><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Msamanga</surname><given-names>Gernard I.</given-names></name><xref ref-type="aff" rid="A6">6</xref></contrib><contrib contrib-type="author"><name><surname>Fawzi</surname><given-names>Wafaie W.</given-names></name><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A5">5</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Nutrition, Harvard School of Public Health, Boston, MA, USA</aff><aff id="A2"><label>2</label>United Nations Children’s Fund, Regional Office for West and Central Africa, Dakar, Senegal</aff><aff id="A3"><label>3</label>Unaffiliated</aff><aff id="A4"><label>4</label>Department of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany</aff><aff id="A5"><label>5</label>Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA</aff><aff id="A6"><label>6</label>Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania</aff><author-notes><corresp id="cor1">Correspondence: Roland Kupka, UNICEF Regional Office for West and Central Africa, P.O. Box 29720, Dakar-Yoff, Senegal. <email>rkupka@post.harvard.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>30</day><month>9</month><year>2009</year></pub-date><pub-date pub-type="ppub"><year>2009</year></pub-date><pub-date pub-type="pmc-release"><day>1</day><month>1</month><year>2010</year></pub-date><volume>88</volume><issue>5</issue><fpage>584</fpage><lpage>592</lpage><permissions><copyright-statement>© 2009 Informa UK Ltd.</copyright-statement><copyright-year>2009</copyright-year></permissions><abstract><sec id="S1"><title>Objective</title><p id="P1">To determine maternal risk factors for stillbirth among pregnant HIV-infected women in sub-Saharan Africa.</p></sec><sec id="S2"><title>Design</title><p id="P2">Prospective cohort study nested within a micronutrient trial. At enrollment, maternal sociodemographic, obstetric, immunologic, clinical, and nutritional variables were measured. Women were followed through monthly clinic visits until delivery. Multivariate predictors of stillbirth were identified in Poisson regression models.</p></sec><sec id="S3"><title>Setting</title><p id="P3">Antenatal clinic in a tertiary care hospital in urban Dar es Salaam, Tanzania.</p></sec><sec id="S4"><title>Population</title><p id="P4"><italic>N</italic> = 1,078 women enrolled between 12 and 27 weeks of gestation.</p></sec><sec id="S5"><title>Main outcome measures</title><p id="P5">Stillbirth (delivery of dead baby ≥ 28 weeks’ gestation), fresh stillbirth, and macerated stillbirth.</p></sec><sec id="S6"><title>Results</title><p id="P6">Among 1,017 singleton pregnancies, there were 49 stillbirths, yielding a stillbirth risk of 50.0 per 1,000 deliveries (95% Confidence Interval(CI) = 37.2, 65.6). Of stillbirths with known type, 53.7% were fresh and 46.3% macerated. In multivariate analyses, baseline measures of late ( ≥ 21 weeks’ gestation) study entry (Relative Risk (RR) = 2.13, 95% CI = 1.17, 3.87), CD3 count ≥ 1,179 cells/ml (RR = 2.15, 95% CI = 1.16, 4.01), stillbirth history (RR = 3.53, 95% CI = 1.30, 9.59), primiparity (RR = 3.65, 95% CI = 1.83, 7.29), and syphilis infection (RR = 2.06, 95% CI = 1.09, 3.88) predicted increased stillbirth risk. Late study entry, illiteracy, stillbirth history, primiparity, CD3 count ≥ 1,179 cells/ml, gonorrhea infection, and previous hospitalization predicted increased risk of fresh stillbirth, while living alone and syphilis infection predicted increased risk of macerated stillbirth.</p></sec><sec id="S7"><title>Conclusions</title><p id="P7">Applying antenatal screening and preventive tools for the socioeconomic, obstetric, immunologic, and clinical risk factors identified may assist in reducing the high incidence of stillbirth among HIV-infected women in urban sub-Saharan Africa.</p></sec></abstract><kwd-group><kwd>Predictors</kwd><kwd>pregnancy</kwd><kwd>HIV</kwd><kwd>stillbirth</kwd><kwd>Tanzania</kwd></kwd-group><contract-num rid="HD1">R01 HD032257-10A1
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