Risk factors for adverse pregnancy events and correlation with HIV immune reconstitution inflammatory response among women of reproductive age in selected hospitals, Nairobi, Kenya

Abstract

Introduction: More than 10% of the global disease burden is due to pregnancy complications and related birth outcomes and despite recent advances in obstetric medicine, it remains a public health concern.

Objective: This study sought to determine the incidence and risk factors for adverse pregnancy outcomes and association with maternal-HIV-immune reconstitution inflammatory Syndrome (IRIS).

Design: A prospective cohort was used. Subjects were followed from the end of first trimester for six and half months. Chi-square test was used to establish the association between the variables at p-value < 0.05. Regression analysis was performed to identify  independent predictors of APFOs. Adjusted odds ratio at 95% confidence interval was determined.

Setting: Kenyatta National and Mbagathi Hospitals, Nairobi County, Kenya. 

Results: Cumulative incidence of APFOs were 27(26.5%) compared to 11(10.8%) in IRIS cases versus non-IRIS cases respectively. Women with IRIS had 2.46 relative risk of experiencing an adverse pregnancy outcome compared to those without IRIS.

Conclusion: Maternal HIV-IRIS was significantly associated with adverse pregnancy outcome in bivariate analysis. Multiple regression dropped maternal HIV-IRIS revealing the following as independent predictors: HIV-RNA viral load at baseline of above 50 copies/ml [AOR=2.7; 95%CI: 1.2-6.3; P=.017], Maternal placental syndrome hypertensive event [AOR=0.1; 95%CI: 0.0-1.0; P = .052] and mother’s general health during delivery [AOR= 4; 95%CI: 4.0:1.8-9.1; P=.001].