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Background: We have recently detected an increasing number of pre-eclampsia and fetal death in HIV-infected pregnant women receiving highly active antiretroviral therapy (HAART). We aimed to study the incidence and the risk for pre-eclampsia and fetal death in HIV-infected women.

Methods: Retrospective study of all pregnant women who delivered (at least 22 weeks of gestation) in our institution. HIV serology is routinely offered to all pregnant women and antiretroviral therapy is provided to those ones HIV-infected according to current guidelines. Cases of pre-eclampsia and fetal death were identified from hospital files. Characteristics of HIV- and no-HIV-infected patients were compared. Factors related to demographics, pregnancy, HIV infection, and antiretroviral therapy were assessed to detect any potential association with pre-eclampsia and fetal death.

Results: From November 1985 until August 2003, 472 HIV-infected pregnant women have been followed: 258 from 1985 to 1994 (no antiretroviral therapy period), 74 from 1994 to 1998 (mono/double therapy period), and 140 from 1998 to 2003 (HAART period). Vertical transmission in these 3 periods was 12%, 4%, and 0%, respectively. Cases of pre-eclampsia and fetal death were:  0 (0%) and 2 (0.8%), 0 (0%) and 0 (0%), and 9 (6.4%), and 6 (4.2%), respectively. From Juanuary 2001 until August 2003, 8768 women delivered at our institution and 82 (0.9%) were HIV-infected. In that period, the rates of pre-eclampsia (9 HIV-infected [11.0%] vs 242 non-HIV-infected [2.8%]; RR 4.3 95%CI 1.9-9.0) and fetal death (5 HIV-infected, 6.1% vs 41 non-HIV-infected, 0.5%; RR 13.7 95%CI:  5.3 to 35.6) were significantly higher in HIV-infected women (p <0.01). Pre-eclampsia was associated with fetal death in 3/9 (33%) HIV-infected women compared with 3/242 (1.2%) non-HIV-infected women (p <0.001). In the general population, risk factors (OR; 95%CI) for pre-eclampsia were HIV infection (4.9; 2.4 to 10.1), gemelar pregnancy (3.6; 2.3 to 5.7), and nuliparity (1.3; 1.01 to 1.7); and for fetal death were HIV infection (10.2; 3.4 to 30.8) and drug addiction (4.2; 1.02 to 17.2). HIV-infected patients developing pre-eclampsia and fetal death had been exposed longer to antiretroviral therapy prior to and during pregnancy than with those without.

Conclusions: An unexpected high rate of pre-eclampsia and fetal death has been identified in HIV-infected pregnant women on HAART. Longer exposure to antiretroviral therapy prior to and during pregnancy were identified as factors associated with a higher risk. If our findings are confirmed, they may lead to change current recommendations on pregnancy in HIV-infected women.

Keywords: Pre-eclampsia; Fetal death; Obstetrical complications