Analysis on adverse pregnancy outcome of HIV-infected pregnant women and influencing factors in Guangdong, 2011−2020
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摘要:
目的 描述广东省人类免疫缺陷病毒（HIV）感染孕产妇不良妊娠结局的情况，分析导致不良妊娠结局的影响因素，促进艾滋病感染孕产妇及暴露儿童的健康。 方法 对广东省2011—2020年所有区/县确认的3 438例HIV感染孕产妇的相关信息进行χ2检验和非条件logistic回归分析。 结果 共3 438例HIV感染孕妇纳入研究， 955例孕妇发生不良妊娠结局，不良妊娠结局发生率为27.78%。 不同的文化程度、初检时期、传播途径、产次和确认感染时期和妊娠高血压会影响HIV感染孕产妇不良妊娠结局的发生，差异有统计学意义（P<0.05）。 多因素logistic回归分析显示，注射毒品感染、产时或产后确认感染和患有妊娠高血压的HIV感染孕产妇发生不良妊娠结局的OR值分别是1.65（1.04～2.58）、0.61（0.48～0.78）和2.27（1.35～3.80）。 结论 传播途径、确认感染时期及妊娠高血压和HIV感染孕产妇发生不良妊娠结局有关。 需要高度重视HIV感染孕妇的生殖健康，提供优质的咨询服务和孕期保健服务，保障HIV感染孕产妇的健康，改善妊娠结局。 Abstract:Objective To investigate the incidence of adverse pregnancy outcomes of HIV-infected pregnant women and its influencing factors in Guangdong province and provide evidence to protect the health of HIV-infected pregnant women and exposed children. Methods The information about3 438 HIV infected pregnant women in all districts and counties of Guangdong from 2011 to 2020 were analyzed by χ2 test and non-conditional logistic regression model. Results The incidence rate of adverse pregnancy outcome in HIV infected pregnant women was 27.78% (955/3 438). The differences in education level, initial detection time, transmission route, parity, infection confirmation time and gestational hypertension on the incidence of adverse pregnancy outcome had significance (P<0.05). Multivariate logistic regression analysis showed that the ORs of adverse pregnancy outcomes in HIV-infected pregnant women who were infected by injecting drug use, had infection confirmation during or after delivery and had gestational hypertension were 1.65 (1.04−2.58), 0.61 (0.48−0.78) and 2.27 (1.35−3.80). Conclusion Transmission route, infection confirmation time and gestational hypertension were related to adverse pregnancy outcomes of HIV-infected women in Guangdong during this period. It is necessary to attach great importance to the reproductive health of HIV-infected pregnant women, provide high-quality consultation and pregnancy health care services to protect the health of HIV-infected pregnant women and improve pregnancy outcomes. -
Key words:
- Human immunodeficiency virus /
- Pregnant women /
- Adverse pregnancy outcome
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表 1 人类免疫缺陷病毒感染孕产妇妊娠结局影响因素的单因素分析
Table 1. Univariate analysis on influencing factors of adverse pregnancy outcome of HIV-infected pregnant women
因素 HIV感染 孕产妇 妊娠结局 χ2值 P值 健康分娩 不良妊娠结局 数量（例） 构成比（%） 数量（例） 构成比（%） 数量（例） 构成比（%） 年龄组（岁） 4.88 0.087 ≤20 183 5.32 135 73.77 48 26.23 21～ 1 867 54.30 1374 73.59 493 26.41 31～ 1 388 40.38 974 70.17 414 29.83 文化程度 9.93 0.019 初中及以下 2 412 70.16 1 756 72.80 656 27.20 高中 610 17.74 436 71.48 174 28.52 大学及以上 238 6.92 180 75.63 58 24.37 不详 177 5.15 111 62.71 66 37.29 民族 0.16 0.689 汉族 2 901 84.38 2 091 72.08 810 27.92 其他 534 15.79 390 73.03 144 26.97 职业 3.08 0.079 家务及待业 1 796 52.24 1 321 73.55 475 26.45 其他 1 641 47.73 1 163 70.83 479 29.17 婚姻状况 3.51 0.061 已婚（初婚或再婚） 2 746 79.87 2 004 72.98 742 7.02 单身 692 20.13 479 69.32 212 30.68 初检时期 9.02 0.029 孕早期 1 200 34.90 844 70.33 356 29.67 孕中期 995 28.94 710 71.36 285 28.64 孕晚期 953 27.72 723 75.87 230 24.13 不详 290 8.44 206 71.03 84 28.97 传播途径 7.67 0.022 性传播 1 793 52.15 1 290 71.95 503 28.05 注射毒品 87 2.53 52 59.77 35 40.23 其他或不详 1 557 45.32 1 141 73.28 416 26.72 产次 6.46 0.011 初产妇 1 166 33.92 810 69.47 356 31.53 经产妇 2 272 66.38 1673 73.64 599 26.36 确认感染时期 8.27 0.016 孕前 1 762 51.25 1246 70.72 516 29.28 孕期 1 110 32.29 807 72.71 303 27.29 产时或产后 566 16.46 430 75.97 136 24.03 开始用药时期 5.23 0.160 孕期 2 273 66.11 1 649 72.55 624 27.45 产时 223 6.49 183 82.06 40 17.94 产后或未用药 942 27.40 651 69.11 291 30.89 中重度贫血 0.55 0.457 是 3 300 95.99 2 379 72.09 921 27.91 否 138 4.01 104 75.36 34 24.64 妊娠高血压 8.65 0.003 是 62 1.80 34 54.84 28 45.16 否 3 376 98.20 2 449 72.54 927 27.46 妊娠合并糖尿病 0.00 1.000 是 3 345 97.29 2 416 72.23 929 27.77 否 93 2.71 67 72.04 26 27.96 
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表 2 人类免疫缺陷病毒感染孕产妇不良妊娠结局多因素非条件logistic回归分析
Table 2. Multivariate conditional logistic regression analysis on adverse pregnancy outcomes of HIV-infected pregnant women
因素 β $s_{ \bar x}$ χ2值 P值 Exp （β） 95%CI 常数 −0.63 0.11 30.39 <0.001 0.53 0.43～0.67 文化程度 初中及以下 1.00 高中 −0.02 0.10 0.05 0.820 0.98 0.80～1.19 大学及以上 −0.28 0.16 3.01 0.083 0.75 0.55～1.03 不详 0.49 0.17 8.67 0.003 1.63 1.17～2.25 初检时期 孕早期 1.00 孕中期 −0.04 0.10 0.18 0.070 0.96 0.80～1.16 孕晚期 −0.14 0.11 1.61 0.205 0.86 0.70～1.08 不详 0.08 0.15 0.27 0.605 1.08 0.80～1.46 传播途径 性传播 1.00 注射毒品 0.50 0.23 4.71 0.030 1.65 1.04～2.58 其他或不详 −0.06 0.08 0.53 0.465 0.94 0.81～1.10 产次 初产妇 1.00 经产妇 −0.13 0.08 2.21 0.137 0.88 0.75～1.04 确认感染时期 孕前 1.00 孕期 −0.18 0.10 3.35 0.067 0.84 0.70～1.01 产时或产后 −0.49 0.12 15.52 <0.001 0.61 0.48～0.78 妊娠高血压 否 1.00 是 0.82 0.26 9.72 0.002 2.27 1.35～3.80
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