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Navér L, Albert J, Carlander C, Gisslén M, Pettersson K, Soeria-Atmadja S, Sönnerborg A, Westling K, Yilmaz A, Pettersson K. Prophylaxis and treatment of HIV infection in pregnancy, Swedish guidelines 2024. Infect Dis (Lond) 2024; 56:657-668. [PMID: 38805265 DOI: 10.1080/23744235.2024.2360029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
In May 2024, the Swedish Reference Group on Antiviral Therapy updated the guidelines on management of HIV infection in pregnancy. The most important recommendations and revisions were: (i) ART during pregnancy should be started as early as possible and continue after delivery; (ii) Suppressive ART should normally not be modified; (iii) The treatment target of HIV RNA <20 copies/ml remains; (iv) Dolutegravir/emtricitabine/tenofovir DF is the first-line drug combination also in pregnant women and women planning pregnancy; (v) There is no evidence of an increased risk of neural tube defects associated with dolutegravir; (vi) Mode of delivery for women with effective ART and HIV RNA <200 copies/ml should follow standard obstetric procedures; (vii) Caesarean section is recommended if HIV RNA ≥200 copies/ml; (viii) Scalp electrode, foetal blood sampling and/or vacuum delivery should be used on strict indications, but does not necessitate intensified infant prophylaxis; (ix) Management and mode of delivery in case of premature or full-term rupture of membranes should follow standard obstetric procedures; (x) Recommended infant antiretroviral prophylaxis has been updated; (xi) The duration of infant antiretroviral prophylaxis (gestational age ≥35 weeks and mother on effective ART and HIV RNA <200 copies/ml) has been changed from 4 to 2 weeks; (xii) Infants born to women with HIV RNA ≥200 copies/ml should receive 4 weeks of combination prophylaxis; (xiii) Fertility evaluation and assisted reproduction should be offered to women on suppressive ART according to the same principles as for other women; (xiv) Women living with HIV should still be advised against breastfeeding; (xv) Women who nevertheless opt to breastfeed should be offered intensified support and follow-up.
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Affiliation(s)
- Lars Navér
- Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Jan Albert
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Christina Carlander
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, University of Göteborg, Göteborg, Sweden
- Department of Infectious, Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Göteborg, Sweden
- Public Health Agency of Sweden, Solna, Sweden
| | - Kristina Pettersson
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Sandra Soeria-Atmadja
- Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Anders Sönnerborg
- Department of Clinical Virology, Karolinska University Hospital, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Westling
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Aylin Yilmaz
- Department of Infectious Diseases, University of Göteborg, Göteborg, Sweden
- Department of Infectious, Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Karin Pettersson
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Giovannopoulou E, Tsakiridis I, Mamopoulos A, Kalogiannidis I, Papoulidis I, Athanasiadis A, Dagklis T. Invasive Prenatal Diagnostic Testing for Aneuploidies in Singleton Pregnancies: A Comparative Review of Major Guidelines. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1472. [PMID: 36295632 PMCID: PMC9609299 DOI: 10.3390/medicina58101472] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/22/2022]
Abstract
Sophisticated screening protocols for genetic abnormalities constitute an important component of current prenatal care, aiming to identify high-risk pregnancies and offer appropriate counseling to parents regarding their options. Definite prenatal diagnosis is only possible by invasive prenatal diagnostic testing (IPDT), mainly including amniocentesis and chorionic villous sampling (CVS). The aim of this comparative review was to summarize and compare the existing recommendations on IPDT from the most influential guidelines. All the reviewed guidelines highlight that IPDT is indicated based on a positive screening test rather than maternal age alone. Other indications arise from medical history and sonography, with significant variations identified between the guidelines. The earlier time for amniocentesis is unequivocally set at ≥15 gestational weeks, whereas for CVS, the earlier limit varies from ≥10 to ≥11 weeks. Certain technical aspects and the overall approach demonstrate significant differences. Periprocedural management regarding Rhesus alloimmunization, virologic status and use of anesthesia or antibiotics are either inconsistent or insufficiently addressed. The synthesis of an evidence-based algorithm for IPDT is of crucial importance to healthcare professionals implicated in prenatal care to avoid unnecessary interventions without compromising optimal prenatal care.
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Affiliation(s)
- Eirini Giovannopoulou
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Ioannis Kalogiannidis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Ioannis Papoulidis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
- Access to Genome—ATG, Clinical Laboratory Genetics, 551 34 Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
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Zhou Y, Song Z, Sun L, Wang Y, Lin X, Zhang D. Prenatal Diagnosis Nomograms: A Novel Tool to Predict Fetal Chromosomal Abnormalities in High-Risk Patients. Risk Manag Healthc Policy 2021; 14:4523-4535. [PMID: 34764710 PMCID: PMC8575375 DOI: 10.2147/rmhp.s327788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background Amniocentesis is an invasive prenatal diagnostic technique that can provide genetic information of fetus for pregnant women and give them a choice. A straightforward predictive tool can show pregnant women the need for amniocentesis prior to the procedure. Methods The information of patients who underwent amniocentesis from 2014 to 2019 at the Obstetrics Clinic, Shengjing Hospital of China Medical University was extracted, and important independent prognostic factors were determined by univariate and multivariate logistic regression analysis to construct nomograms with total abnormalities (TA) and chromosome number abnormalities (CNA). Results A total of 19,683 patients undergoing amniocentesis were included in this study. Among 1761 patients with abnormal results, 917 had abnormal chromosome numbers, 439 had abnormal chromosome structures, and 405 had polymorphic results. Nomograms of TA and CNA were created using data such as age, nuchal translucency value, ultrasound results, Oscar’s testing and/or non-invasive prenatal testing abnormalities, parental chromosomes, and information whether they were twins. The nomogram has good predictive power and clinical practicality through the analysis of area under curve and decision curve analysis. Internal verification was performed for nomograms of TA and CNA, suggesting that the nomogram’s predicted probability and actual probability of the two are consistent. Conclusion The nomogram constructed is a good predictor of TA and CNA, which can be used in clinical practice to screen high-risk patients of chromosomal abnormalities.
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Affiliation(s)
- Yangzi Zhou
- Shengjing Hospital of China Medical University, Department of Obstetrics and Gynecology, Shenyang, People's Republic of China
| | - Zixuan Song
- Shengjing Hospital of China Medical University, Department of Obstetrics and Gynecology, Shenyang, People's Republic of China
| | - Lu Sun
- Shengjing Hospital of China Medical University, Department of Obstetrics and Gynecology, Shenyang, People's Republic of China.,Shengjing Hospital of China Medical University, Department of Clinical Genetics, Shenyang, People's Republic of China
| | - Yuting Wang
- Shengjing Hospital of China Medical University, Department of Obstetrics and Gynecology, Shenyang, People's Republic of China
| | - Xiting Lin
- Shengjing Hospital of China Medical University, Department of Obstetrics and Gynecology, Shenyang, People's Republic of China
| | - Dandan Zhang
- Shengjing Hospital of China Medical University, Department of Obstetrics and Gynecology, Shenyang, People's Republic of China
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Navaratnam K, Alfirevic Z. Amniocentesis and chorionic villus sampling: Green-top Guideline No. 8. BJOG 2021; 129:e1-e15. [PMID: 34693616 DOI: 10.1111/1471-0528.16821] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lee JY, Kwon JY, Na S, Choe SA, Seol HJ, Kim M, Kim MA, Park CW, Kim K, Ryu HM, Hwang HS, Shim JY. Clinical Practice Guidelines for Prenatal Aneuploidy Screening and Diagnostic Testing from Korean Society of Maternal-Fetal Medicine: (2) Invasive Diagnostic Testing for Fetal Chromosomal Abnormalities. J Korean Med Sci 2021; 36:e26. [PMID: 33496085 PMCID: PMC7834898 DOI: 10.3346/jkms.2021.36.e26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/06/2020] [Indexed: 11/20/2022] Open
Abstract
The Korean Society of Maternal Fetal Medicine proposed the first Korean guideline on prenatal aneuploidy screening and diagnostic testing, in April 2019. The clinical practice guideline (CPG) was developed for Korean women using an adaptation process based on good-quality practice guidelines, previously developed in other countries, on prenatal screening and invasive diagnostic testing for fetal chromosome abnormalities. We reviewed current guidelines and developed a Korean CPG on invasive diagnostic testing for fetal chromosome abnormalities according to the adaptation process. Recommendations for selected 11 key questions are: 1) Considering the increased risk of fetal loss in invasive prenatal diagnostic testing for fetal genetic disorders, it is not recommended for all pregnant women aged over 35 years. 2) Because early amniocentesis performed before 14 weeks of pregnancy increases the risk of fetal loss and malformation, chorionic villus sampling (CVS) is recommended for pregnant women who will undergo invasive prenatal diagnostic testing for fetal genetic disorders in the first trimester of pregnancy. However, CVS before 9 weeks of pregnancy also increases the risk of fetal loss and deformity. Thus, CVS is recommended after 9 weeks of pregnancy. 3) Amniocentesis is recommended to distinguish true fetal mosaicism from confined placental mosaicism. 4) Anti-immunoglobulin should be administered within 72 hours after the invasive diagnostic testing. 5) Since there is a high risk of vertical transmission, an invasive prenatal diagnostic testing is recommended according to the clinician's discretion with consideration of the condition of the pregnant woman. 6) The use of antibiotics is not recommended before or after an invasive diagnostic testing. 7) The chromosomal microarray test as an alternative to the conventional cytogenetic test is not recommended for all pregnant women who will undergo an invasive diagnostic testing. 8) Amniocentesis before 14 weeks of gestation is not recommended because it increases the risk of fetal loss and malformation. 9) CVS before 9 weeks of gestation is not recommended because it increases the risk of fetal loss and malformation. 10) Although the risk of fetal loss associated with invasive prenatal diagnostic testing (amniocentesis and CVS) may vary based on the proficiency of the operator, the risk of fetal loss due to invasive prenatal diagnostic testing is higher in twin pregnancies than in singleton pregnancies. 11) When a monochorionic twin is identified in early pregnancy and the growth and structure of both fetuses are consistent, an invasive prenatal diagnostic testing can be performed on one fetus alone. However, an invasive prenatal diagnostic testing is recommended for each fetus in cases of pregnancy conceived via in vitro fertilization, or in cases in which the growth of both fetuses differs, or in those in which at least one fetus has a structural abnormality. The guidelines were established and approved by the Korean Academy of Medical Sciences. This guideline is revised and presented every 5 years.
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Affiliation(s)
- Ji Yeon Lee
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Ji Young Kwon
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sunghun Na
- Department of Obstetrics and Gynecology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seung Ah Choe
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyun Joo Seol
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Minhyoung Kim
- Department of Obstetrics and Gynecology, MizMedi Hospital, Seoul, Korea
| | - Min A Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Wook Park
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | - Hyun Mee Ryu
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Han Sung Hwang
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
| | - Jae Yoon Shim
- Mirae & Heemang Obstetrics and Gynecology Clinic, Seoul, Korea.
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Gilleece DY, Tariq DS, Bamford DA, Bhagani DS, Byrne DL, Clarke DE, Clayden MP, Lyall DH, Metcalfe DR, Palfreeman DA, Rubinstein DL, Sonecha MS, Thorley DL, Tookey DP, Tosswill MJ, Utting MD, Welch DS, Wright MA. British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018. HIV Med 2020; 20 Suppl 3:s2-s85. [PMID: 30869192 DOI: 10.1111/hiv.12720] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Dr Yvonne Gilleece
- Honorary Clinical Senior Lecturer and Consultant Physician in HIV and Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust
| | - Dr Shema Tariq
- Postdoctoral Clinical Research Fellow, University College London, and Honorary Consultant Physician in HIV, Central and North West London NHS Foundation Trust
| | - Dr Alasdair Bamford
- Consultant in Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London
| | - Dr Sanjay Bhagani
- Consultant Physician in Infectious Diseases, Royal Free Hospital NHS Trust, London
| | - Dr Laura Byrne
- Locum Consultant in HIV Medicine, St George's University Hospitals NHS Foundation Trust, London
| | - Dr Emily Clarke
- Consultant in Genitourinary Medicine, Royal Liverpool and Broadgreen University Hospitals NHS Trust
| | - Ms Polly Clayden
- UK Community Advisory Board representative/HIV treatment advocates network
| | - Dr Hermione Lyall
- Clinical Director for Children's Services and Consultant Paediatrician in Infectious Diseases, Imperial College Healthcare NHS Trust, London
| | | | - Dr Adrian Palfreeman
- Consultant in Genitourinary Medicine, University Hospitals of Leicester NHS Trust
| | - Dr Luciana Rubinstein
- Consultant in Genitourinary Medicine, London North West Healthcare University NHS Trust, London
| | - Ms Sonali Sonecha
- Lead Directorate Pharmacist HIV/GUM, Chelsea and Westminster Healthcare NHS Foundation Trust, London
| | | | - Dr Pat Tookey
- Honorary Senior Lecturer and Co-Investigator National Study of HIV in Pregnancy and Childhood, UCL Great Ormond Street Institute of Child Health, London
| | | | - Mr David Utting
- Consultant Obstetrician and Gynaecologist, Brighton and Sussex University Hospitals NHS Trust
| | - Dr Steven Welch
- Consultant in Paediatric Infectious Diseases, Heart of England NHS Foundation Trust, Birmingham
| | - Ms Alison Wright
- Consultant Obstetrician and Gynaecologist, Royal Free Hospitals NHS Foundation Trust, London
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Abstract
Importance There are approximately 284,500 adolescent and adult women living with human immunodeficiency virus (HIV) in the United States. It is estimated that approximately 8500 of these women give birth annually. While the rate of perinatal transmission in the United States has decreased by more than 90% since the early 1990s, potentially preventable HIV transmission events still occur and cause significant morbidity and mortality. Objective The aim of this review was to summarize the current data regarding perinatal HIV transmission timing and risk factors, current management recommendations, and implications of timing of transmission on patient management. Evidence Acquisition Literature review. Results This review reiterates that the risk of perinatal HIV transmission can be reduced to very low levels by following current recommendations for screening for HIV in all pregnant women and properly treating HIV-infected mothers, as well as using evidence-based labor management practices. Conclusions and Relevance Familiarity with the pathogenesis of HIV transmission is important for obstetric care providers to appropriately manage HIV-infected women in pregnancy, intrapartum, and the postpartum period.
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Navér L, Albert J, Carlander C, Flamholc L, Gisslén M, Karlström O, Svedhem-Johansson V, Sönnerborg A, Westling K, Yilmaz A, Pettersson K. Prophylaxis and treatment of HIV-1 infection in pregnancy - Swedish Recommendations 2017. Infect Dis (Lond) 2018; 50:495-506. [PMID: 29363407 DOI: 10.1080/23744235.2018.1428825] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Prophylaxis and treatment with antiretroviral drugs have resulted in a very low rate of mother-to-child transmission (MTCT) of HIV during recent years. Registration of new antiretroviral drugs, modification of clinical praxis, updated general treatment guidelines and increasing knowledge about MTCT have necessitated regular revisions of the recommendations for 'Prophylaxis and treatment of HIV-1 infection in pregnancy'. The Swedish Reference Group for Antiviral Therapy (RAV) has updated the recommendations from 2013 at an expert meeting 19 September 2017. In the new text, current treatment guidelines for non-pregnant are considered. The most important revisions are that: (1) Caesarean section and infant prophylaxis with three drugs are recommended when maternal HIV RNA >150 copies/mL (previously >50 copies/mL). The treatment target of undetectable HIV RNA remains unchanged <50 copies/mL; (2) Obstetric management and mode of delivery at premature rupture of the membranes and rupture of the membranes at full term follow the same procedures as in HIV negative women; (3) Vaginal delivery is recommended to a well-treated woman with HIV RNA <150 copies/mL regardless of gestational age, if no obstetric contraindications are present; (4) Treatment during pregnancy should begin as soon as possible and should continue after delivery; (5) Ongoing well-functioning HIV treatment at pregnancy start should usually be retained; (6) Recommended drugs and drug combinations have been updated.
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Affiliation(s)
- Lars Navér
- a Department of Pediatrics , Karolinska University Hospital , Stockholm , Sweden.,b Department of Clinical Science , Intervention and Technology (CLINTEC), Karolinska Institutet , Stockholm , Sweden
| | - Jan Albert
- c Department of Clinical Microbiology , Karolinska University Hospital , Stockholm , Sweden.,d Department of Microbiology, Tumor and Cell Biology (MTC) , Karolinska Institutet , Stockholm , Sweden
| | | | - Leo Flamholc
- f Department of Infectious Diseases , Malmö University Hospital , Malmö , Sweden
| | - Magnus Gisslén
- g Department of Infectious Diseases , University of Gothenburg , Gothenburg , Sweden
| | - Olof Karlström
- h Medical Products Agency , Uppsala , Sweden.,i Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Veronica Svedhem-Johansson
- i Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,j Department of Medicine , Karolinska Institutet , Stockholm , Sweden
| | - Anders Sönnerborg
- i Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,k Department of Laboratory Medicine , Karolinska Institutet , Stockholm , Sweden.,l Department of Clinical Virology , Karolinska University Hospital , Stockholm , Sweden
| | - Katarina Westling
- i Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,j Department of Medicine , Karolinska Institutet , Stockholm , Sweden
| | - Aylin Yilmaz
- g Department of Infectious Diseases , University of Gothenburg , Gothenburg , Sweden
| | - Karin Pettersson
- b Department of Clinical Science , Intervention and Technology (CLINTEC), Karolinska Institutet , Stockholm , Sweden.,m Department of Obstetrics and Gynecology , Karolinska University Hospital , Stockholm , Sweden
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Ghi T, Sotiriadis A, Calda P, Da Silva Costa F, Raine-Fenning N, Alfirevic Z, McGillivray G. ISUOG Practice Guidelines: invasive procedures for prenatal diagnosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:256-268. [PMID: 27485589 DOI: 10.1002/uog.15945] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/15/2016] [Indexed: 06/06/2023]
Affiliation(s)
- T Ghi
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - A Sotiriadis
- Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P Calda
- Department of Obstetrics and Gynecology, Charles University in Prague, First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic
| | - F Da Silva Costa
- Monash Ultrasound for Women and Perinatal Services, Monash Medical Centre, Melbourne, Victoria, Australia
| | - N Raine-Fenning
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK - Nurture Fertility, The Fertility Partnership
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - G McGillivray
- Victorian Clinical Genetics Services, Mercy Hospital for Women, Murdoch Children's Research Institute, Melbourne, Australia
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Chougrani I, Muller F, Marcelin L, Tsatsaris V, Abric J, Luton D, Guibourdenche J, Azria E. Combined first-trimester Down syndrome screening in HIV-infected women. Eur J Obstet Gynecol Reprod Biol 2016; 203:274-8. [PMID: 27391901 DOI: 10.1016/j.ejogrb.2016.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/16/2016] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine if human immunodeficiency virus (HIV) infection or antiretroviral therapy interferes with maternal levels of free human β-chorionic gonadotrophin (hCGβ) and pregnancy-associated plasma protein-A (PAPP-A) and whether any such influence alters first-trimester Down syndrome (DS) screening in HIV-infected women. STUDY DESIGN We performed a multicenter 1:2 matched case-control study comparing 84 HIV-infected women with singleton pregnancies with controls randomly selected among uninfected women, delivered and screened in the same center and matched for maternal age, geographical origin and fetal sex. RESULTS Groups did not differ significantly in screening results, although case women showed a slightly lower median free hCGβ multiple of the median (MoM) (1.11 versus 1.24 MoM, p=0.32) and higher median PAPP-A MoM (1.45 versus 1.32 MoM, p=0.23) than control women. The false-positive rate was similar in the case and control groups (5% versus 6.5%, p=0.5). Biomarker levels did not differ when comparing treated and untreated patients with their respective controls, and with one another. CONCLUSION First-trimester DS combined screening biomarker levels and calculated risk do not seem to be significantly altered by HIV infection or antiretroviral treatment. This screening strategy appears to be suitable for HIV-infected women.
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Affiliation(s)
- Imène Chougrani
- Department of Obstetrics and Gynecology, Hopital Bichat Claude Bernard, DHU Risks in Pregnancy, Assistance Publique-Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Françoise Muller
- Department of Biochemistry, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Louis Marcelin
- Centre Hospitalier Universitaire Cochin Broca Hôtel Dieu, Port Royal Maternity, Assistance Publique-Hôpitaux de Paris, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Vassilis Tsatsaris
- Centre Hospitalier Universitaire Cochin Broca Hôtel Dieu, Port Royal Maternity, Assistance Publique-Hôpitaux de Paris, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Judith Abric
- Centre Hospitalier Universitaire Cochin Broca Hôtel Dieu, Port Royal Maternity, Assistance Publique-Hôpitaux de Paris, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, Hopital Bichat Claude Bernard, DHU Risks in Pregnancy, Assistance Publique-Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Jean Guibourdenche
- Hormonology Department, Centre Hospitalier Universitaire Cochin Broca Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Elie Azria
- Maternity Unit, Groupe Hospitalier Paris Saint Joseph, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Inserm U1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé Research Team), Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, DHU Risk in Pregnancy, Paris Descartes University, Paris, France.
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11
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Floridia M, Masuelli G, Meloni A, Cetin I, Tamburrini E, Cavaliere AF, Dalzero S, Sansone M, Alberico S, Guerra B, Spinillo A, Chiadò Fiorio Tin M, Ravizza M. Amniocentesis and chorionic villus sampling in HIV-infected pregnant women: a multicentre case series. BJOG 2016; 124:1218-1223. [PMID: 27319948 DOI: 10.1111/1471-0528.14183] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess in pregnant women with HIV the rates of amniocentesis and chorionic villus sampling (CVS), and the outcomes associated with such procedures. DESIGN Observational study. Data from the Italian National Program on Surveillance on Antiretroviral Treatment in Pregnancy were used. SETTING University and hospital clinics. POPULATION Pregnant women with HIV. METHODS Temporal trends were analysed by analysis of variance and by the Chi-square test for trend. Quantitative variables were compared by Student's t-test and categorical data by the Chi-square test, with odds ratios and 95% confidence intervals calculated. MAIN OUTCOME MEASURES Rate of invasive testing, intrauterine death, HIV transmission. RESULTS Between 2001 and 2015, among 2065 pregnancies in women with HIV, 113 (5.5%) had invasive tests performed. The procedures were conducted under antiretroviral treatment in 99 cases (87.6%), with a significant increase over time in the proportion of tests performed under highly active antiretroviral therapy (HAART) (100% in 2011-2015). Three intrauterine deaths were observed (2.6%), and 14 pregnancies were terminated because of fetal anomalies. Among 96 live newborns, eight had no information available on HIV status. Among the remaining 88 cases with either amniocentesis (n = 75), CVS (n = 12), or both (n = 1), two HIV transmissions occurred (2.3%). No HIV transmission occurred among the women who were on HAART at the time of invasive testing, and none after 2005. CONCLUSIONS The findings reinforce the assumption that invasive prenatal testing does not increase the risk of HIV vertical transmission among pregnant women under suppressive antiretroviral treatment. TWEETABLE ABSTRACT No HIV transmission occurred among women who underwent amniocentesis or CVS under effective anti-HIV regimens.
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Affiliation(s)
- M Floridia
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - G Masuelli
- Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - A Meloni
- Division of Gynaecology and Obstetrics, S. Giovanni di Dio Hospital, University of Cagliari, Cagliari, Italy
| | - I Cetin
- Department of Obstetrics and Gynaecology, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - E Tamburrini
- Department of Infectious Diseases, Catholic University, Rome, Italy
| | - A F Cavaliere
- Department of Obstetrics & Gynaecology, Catholic University, Rome, Italy
| | - S Dalzero
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - M Sansone
- Department of Neurosciences, Reproductive and Dentistry Science, University Federico II, Naples, Naples, Italy
| | - S Alberico
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - B Guerra
- St. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy
| | - A Spinillo
- Department of Obstetrics and Gynaecology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - M Chiadò Fiorio Tin
- Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - M Ravizza
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
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13
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Connolly KA, Eddleman KA. Amniocentesis: A contemporary review. World J Obstet Gynecol 2016; 5:58-65. [DOI: 10.5317/wjog.v5.i1.58] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 10/27/2015] [Accepted: 12/15/2015] [Indexed: 02/05/2023] Open
Abstract
Amniocentesis is an essential tool in obstetrics. Invasive testing remains the only modality for diagnostic genetic testing and the only way to provide comprehensive testing for chromosomal abnormalities. Despite increasing use of cell free fetal deoxyribonucleic acid (DNA) testing, amniocentesis should still be offered to all women who desire more complete and accurate genetic testing. Counseling patients on the limitations of screening tests is of the upmost importance and amniocentesis should continue to be recommended to confirm positive results from cell free fetal DNA testing or in the case of failed cell free fetal DNA test. As cell free fetal DNA screening has not adequately been studied in multiple gestations, its use is not recommended in this population and invasive testing should be offered. Amniocentesis is also very useful in providing additional information in settings other than genetic testing the second and third trimester. If intraamniotic infection is suspected, but the clinical findings are not enough to guide management, amniocentesis can provide testing that can both immediately clarify the picture (interleukin-6, gram stain, glucose levels) and finally confirm the presence of infection (culture). It can also be used to detect the presence of intrauterine viral infections. Additionally, amniocentesis may be used to test for markers of fetal lung maturity. The American Congress of Obstetricians and Gynecologists recommends that amniocentesis for this indication not be used in cases where late preterm delivery is indicated. It may be useful in guiding decision-making, however, when late preterm delivery is indicated, but when exact timing is unclear. Regardless of the indication, amniocentesis appears to be a relatively low risk procedure with minimal risk to the patient. Additional randomized controlled trials are not likely, as they are not feasible to due extremely high number of participants that would be needed to detect a difference in loss rates. Based on current literature, however, the risk of pregnancy loss from second trimester amniocentesis is low in both singleton and twin gestations. We counsel patients that technique has changed since the original studies in the 1970s and feel comfortable quoting a loss rate of 1/500-1/1000 based on contemporary data.
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Floridia M, Mastroiacovo P, Ravizza M, Todros T, Chiadò Fiorio Tin M, Marconi AM, Cetin I, Maruotti GM, Liuzzi G, Pinnetti C, Degli Antoni A, Spinillo A, Guerra B, Tamburrini E. Good prenatal detection rate of major birth defects in HIV-infected pregnant women in Italy. Prenat Diagn 2015; 35:1374-8. [DOI: 10.1002/pd.4696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/09/2015] [Accepted: 09/20/2015] [Indexed: 11/12/2022]
Affiliation(s)
- M. Floridia
- Department of Therapeutic Research and Medicines Evaluation; Istituto Superiore di Sanità; Rome Italy
| | - P. Mastroiacovo
- ICBD, Alessandra Lisi International Centre on Birth Defects and Prematurity; Rome Italy
| | - M. Ravizza
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School; University of Milan; Milan Italy
| | - T. Todros
- Department of Obstetrics and Neonatology; Città della Salute e della Scienza Hospital and University of Turin; Italy
| | - M. Chiadò Fiorio Tin
- Department of Obstetrics and Neonatology; Città della Salute e della Scienza Hospital and University of Turin; Italy
| | - A. M. Marconi
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School; University of Milan; Milan Italy
| | - I. Cetin
- Department of Obstetrics and Gynaecology; Luigi Sacco Hospital and University of Milan; Italy
| | - G. M. Maruotti
- Department of Neurosciences, Reproductive and Dentistry Science; University Federico II; Naples Italy
| | - G. Liuzzi
- I.N.M.I. Lazzaro Spallanzani; Rome Italy
| | | | - A. Degli Antoni
- Department of Infectious Diseases and Hepatology; Azienda Ospedaliera di Parma; Italy
| | - A. Spinillo
- University of Pavia, Department of Obstetrics and Gynaecology; IRCCS Policlinico San Matteo; Pavia Italy
| | - B. Guerra
- St. Orsola-Malpighi General Hospital; University of Bologna; Bologna Italy
| | - E. Tamburrini
- Department of Infectious Diseases; Catholic University; Rome Italy
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Hui L, The S, McCarthy EA, Walker SP. Emerging issues in invasive prenatal diagnosis: Safety and competency in the post-NIPT era. Aust N Z J Obstet Gynaecol 2015; 55:541-6. [PMID: 26303213 DOI: 10.1111/ajo.12396] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/13/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Numbers of invasive prenatal procedures are declining in response to improved aneuploidy screening methods. OBJECTIVE To assess current practice and attitudes of clinicians performing invasive prenatal diagnosis in regard to patient consent and safety, maintaining procedural competence and uptake of chromosomal microarrays (CMAs). METHODS Anonymous online survey of the Australian Association of Obstetrical and Gynaecological Ultrasonologists conducted in March 2015. RESULTS The survey had a 45% response rate with 59 respondents from Australia. Of these, 34 were subspecialists in maternal fetal medicine or obstetric and gynaecological ultrasound. Fifty-six (95%) currently performed amniocentesis or chorionic villus sampling. Of these, 14 (25%) performed <25 procedures and 8 (14%) performed >150 annually, with most respondents (60%) proposing 10-25 amniocenteses/year as adequate activity to maintain their skills. The majority neither expected referrers to provide results of hepatitis B and HIV serology, nor followed up missing results. There was uncertainty regarding the procedure-related vertical transmission risk of HBV in women with high viral load, with most respondents stating they were either unsure of the risk (22%) or that the risk was unknown (30%). Fifty per cent of practitioners routinely ordered CMA after invasive testing; all recommended CMA following a diagnosis of structural abnormality. CONCLUSIONS In a period of declining testing, many Australian specialists are performing <25 procedures annually. Consideration of the potential risks of bloodborne viruses is limited. CMAs are rapidly being incorporated into clinical practice. These data have implications for patient consent and safety, and workforce training and practice.
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Affiliation(s)
- Lisa Hui
- Maternal Fetal Medicine, Department of Perinatal Medicine, The Mercy Hospital for Women, Heidelberg, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,Public Health Genetics, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Stephanie The
- Australian Association of Obstetrical and Gynaecological Ultrasonologists, Sydney, Australia.,Women's and Children's Health, Westmead Hospital, Westmead, New South Wales, Australia
| | - Elizabeth A McCarthy
- Maternal Fetal Medicine, Department of Perinatal Medicine, The Mercy Hospital for Women, Heidelberg, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Susan P Walker
- Perinatal Medicine, The Mercy Hospital for Women, Heidelberg, Victoria, Australia.,Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
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de Ruiter A, Taylor GP, Clayden P, Dhar J, Gandhi K, Gilleece Y, Harding K, Hay P, Kennedy J, Low-Beer N, Lyall H, Palfreeman A, O'Shea S, Tookey P, Tosswill J, Welch S, Wilkins E. British HIV Association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review). HIV Med 2015; 15 Suppl 4:1-77. [PMID: 25604045 DOI: 10.1111/hiv.12185] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Bayer A, Delorme-Axford E, Sleigher C, Frey TK, Trobaugh DW, Klimstra WB, Emert-Sedlak LA, Smithgall TE, Kinchington PR, Vadia S, Seveau S, Boyle JP, Coyne CB, Sadovsky Y. Human trophoblasts confer resistance to viruses implicated in perinatal infection. Am J Obstet Gynecol 2015; 212:71.e1-71.e8. [PMID: 25108145 DOI: 10.1016/j.ajog.2014.07.060] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/11/2014] [Accepted: 07/30/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Primary human trophoblasts were previously shown to be resistant to viral infection, and able to confer this resistance to nontrophoblast cells. Can trophoblasts protect nontrophoblastic cells from infection by viruses or other intracellular pathogens that are implicated in perinatal infection? STUDY DESIGN Isolated primary term human trophoblasts were cultured for 48-72 hours. Diverse nonplacental human cell lines (U2OS, human foreskin fibroblast, TZM-bl, MeWo, and Caco-2) were preexposed to either trophoblast conditioned medium, nonconditioned medium, or miR-517-3p for 24 hours. Cells were infected with several viral and nonviral pathogens known to be associated with perinatal infections. Cellular infection was defined and quantified by plaque assays, luciferase assays, microscopy, and/or colonization assays. Differences in infection were assessed by Student t test or analysis of variance with Bonferroni correction. RESULTS Infection by rubella and other togaviruses, human immunodeficiency virus-1, and varicella zoster was attenuated in cells preexposed to trophoblast-conditioned medium (P < .05), and a partial effect by the chromosome 19 microRNA miR-517-3p on specific pathogens. The conditioned medium had no effect on infection by Toxoplasma gondii or Listeria monocytogenes. CONCLUSION Our findings indicate that medium conditioned by primary human trophoblasts attenuates viral infection in nontrophoblastic cells. Our data point to a trophoblast-specific antiviral effect that may be exploited therapeutically.
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Abstract
Contemporary management of HIV in pregnancy remains a moving target. With the development of newer antiretroviral agents with lower side-effect profiles and laboratory methods for detection and monitoring of HIV, considerable progress has been made. This review examines key concepts in the pathophysiology of HIV and pregnancy with emphasis on perinatal transmission and reviews appropriate screening and diagnostic testing for HIV during pregnancy. Current recommendations for medical, pharmacologic, and obstetric management of women newly diagnosed with HIV during pregnancy and for those women with preexisting infection are discussed. Preconception counseling for HIV+ women as well as postpartum issues are addressed.
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[HIV and pregnancy: 2013 guidelines from the French expert working group]. ACTA ACUST UNITED AC 2014; 43:534-48. [PMID: 24947850 DOI: 10.1016/j.jgyn.2014.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 12/26/2013] [Accepted: 01/16/2014] [Indexed: 01/13/2023]
Abstract
With effective antiretroviral therapy, the risk of mother to child transmission (MTCT) is now under 1%. The 2013 French guidelines emphasize early antiretroviral lifelong antiretroviral therapy. Thus, the current trend for women living with HIV is to take antiretroviral therapy before, during and after their pregnancies. A major issue today is the choice of antiretroviral drugs, to maximize the benefits and minimize the risks of fetal exposure. This requires interdisciplinary care. The use of effective therapies permits gradual but profound changes in obstetric practice. When maternal plasma viral load is controlled (<50 copies/ml), obstetrical care can be more similar to standards in HIV-negative women. Prophylactic cesarean section is recommended when the viral load in late pregnancy is above 400 copies/mL. Intravenous zidovudine during labor is recommended only if the last maternal viral load is>400 copies/mL or in case of complications such as preterm delivery, bleeding or chorio-amnionitis during labor. In case of premature rupture of membranes before 34 weeks, a multidisciplinary decision should be made, based on gestational age and control of maternal viral load; if the woman is under antiretroviral therapy and especially if her viral load is undetectable, steroids and antibiotics should be offered and pregnancy can be continued except in case of signs or symptoms of chorio-amnionitis. Breastfeeding is not recommended in women living with HIV in France, as in industrialized countries. Prophylaxis in the newborn is usually zidovudine for 1 month. In case of significant exposure to HIV perinatally, in particular when, maternal viral load is>1000 copies/mL, prophylactic combination therapy is recommended. Monitoring of the child is necessary to determine whether or not it is free of HIV infection and to monitor possible adverse effects of perinatal exposure to antiretroviral drugs.
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Navér L, Albert J, Böttiger Y, Carlander C, Flamholc L, Gisslén M, Josephson F, Karlström O, Lindborg L, Svedhem-Johansson V, Svennerholm B, Sönnerborg A, Yilmaz A, Pettersson K. Prophylaxis and treatment of HIV-1 infection in pregnancy: Swedish recommendations 2013. ACTA ACUST UNITED AC 2014; 46:401-11. [PMID: 24754479 DOI: 10.3109/00365548.2014.898333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Prophylaxis and treatment with antiretroviral drugs and elective caesarean section delivery have resulted in very low mother-to-child transmission of HIV during recent years. Updated general treatment guidelines and increasing knowledge about mother-to-child transmission have necessitated regular revisions of the recommendations for the prophylaxis and treatment of HIV-1 infection in pregnancy. The Swedish Reference Group for Antiviral Therapy (RAV) updated the recommendations from 2010 at an expert meeting on 11 September 2013. The most important revisions are the following: (1) ongoing efficient treatment at confirmed pregnancy may, with a few exceptions, be continued; (2) if treatment is initiated during pregnancy, the recommended first-line therapy is essentially the same as for non-pregnant women; (3) raltegravir may be added to achieve rapid reduction in HIV RNA; (4) vaginal delivery is recommended if at > 34 gestational weeks and HIV RNA is < 50 copies/ml and no obstetric contraindications exist; (5) if HIV RNA is < 50 copies/ml and delivery is at > 34 gestational weeks, intravenous zidovudine is not recommended regardless of the delivery mode; (6) if HIV RNA is > 50 copies/ml close to delivery, it is recommended that the mother should undergo a planned caesarean section, intravenous zidovudine, and oral nevirapine, and the infant should receive single-dose nevirapine at 48-72 h of age and post-exposure prophylaxis with 2 drugs; (7) if delivery is preterm at < 34 gestational weeks, a caesarean section delivery should if possible be performed, with intravenous zidovudine and oral nevirapine given to the mother, and single-dose nevirapine given to the infant at 48-72 h of age, as well as post-exposure prophylaxis with 2 additional drugs.
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Affiliation(s)
- Lars Navér
- From the Department of Paediatrics, Karolinska University Hospital , Stockholm , Sweden
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Reitter A, Stücker AU, Linde R, Königs C, Knecht G, Herrmann E, Schlößer R, Louwen F, Haberl A. Pregnancy complications in HIV-positive women: 11-year data from the Frankfurt HIV Cohort. HIV Med 2014; 15:525-36. [PMID: 24602285 DOI: 10.1111/hiv.12142] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the study was to assess pregnancy complications in HIV-positive women and changes in the rates of such complications over 11 years in the Frankfurt HIV Cohort. METHODS There were 330 pregnancies in HIV-positive women between 1 January 2002 and 31 December 2012. The rate of pregnancy-related complications, such as gestational diabetes mellitus (GDM), pre-eclampsia and preterm delivery, the mode of delivery and obstetric history were analysed. Maternal and neonatal morbidity/mortality as well as HIV mother-to-child transmission (MTCT) were evaluated. RESULTS In our cohort, GDM was diagnosed in 38 of 330 women (11.4%). Five women (1.5%) developed pre-eclamspia or hypertension. In 16 women (4.8%), premature rupture of membranes (PROM) occurred and 46 women (13.7%) were admitted with preterm contractions. The preterm delivery rate was 36.5% (n = 122), and 26.9% of deliveries (n = 90) were between 34+0 and 36+6 weeks of gestation. Over the observation period, the percentage of women with undetectable HIV viral load (VL) increased significantly (P < 0.001), from 26.1% to 75%, leading to obstetric changes, including an increase in the rate of vaginal deliveries (P < 0.001), from no vaginal births to 50%. The preterm delivery rate decreased significantly (P < 0.001), from 79.2% to 8.3%. There were no significant changes in the rate of GDM, pre-eclampsia, PROM or preterm contractions. CONCLUSIONS In the 11 years of our analysis, there was a significant reduction in the rate of preterm deliveries and an increase in the vaginal delivery rate, possibly reflecting changes in treatment policies in the same period and the availability of more effective antiretroviral therapy options. The rates of complications such as GDM, pre-eclampsia, preterm contractions, PROM and postnatal complications were stable over the 11 years, but were still increased compared with the general population.
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Affiliation(s)
- A Reitter
- Department of Obstetrics and Gynaecology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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22
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Moncada PA, Montoya JG. Toxoplasmosis in the fetus and newborn: an update on prevalence, diagnosis and treatment. Expert Rev Anti Infect Ther 2014; 10:815-28. [DOI: 10.1586/eri.12.58] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Prenatal ultrasound screening for fetal anomalies and outcomes in high-risk pregnancies due to maternal HIV infection: a retrospective study. Infect Dis Obstet Gynecol 2013; 2013:208482. [PMID: 24194633 PMCID: PMC3803124 DOI: 10.1155/2013/208482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 11/29/2022] Open
Abstract
Objective. To assess the prevalence of prenatal screening and of adverse outcome in high-risk pregnancies due to maternal HIV infection. Study Design. The prevalence of prenatal screening in 330 pregnancies of HIV-positive women attending the department for prenatal screening and/or during labour between January 1, 2002 and December 31, 2012, was recorded. Screening results were compared with the postnatal outcome and maternal morbidity, and mother-to-child transmission (MTCT) was evaluated. Results. One hundred of 330 women (30.5%) had an early anomaly scan, 252 (74.5%) had a detailed scan at 20–22 weeks, 18 (5.5%) had a detailed scan prior to birth, and three (0.9%) had an amniocentesis. In seven cases (2.12%), a fetal anomaly was detected prenatally and confirmed postnatally, while in eight (2.42%) an anomaly was only detected postnatally, even though a prenatal scan was performed. There were no anomalies in the unscreened group. MTCT occurred in three cases (0.9%) and seven fetal and neonatal deaths (2.1%) were reported. Conclusion. The overall prevalence of prenatal ultrasound screening in our cohort is 74.5%, but often the opportunity for prenatal ultrasonography in the first trimester is missed. In general, the aim should be to offer prenatal ultrasonography in the first trimester in all pregnancies. This allows early reassurance or if fetal disease is suspected, further steps can be taken.
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Amniocentesis in HIV pregnant women: 16 years of experience. Infect Dis Obstet Gynecol 2013; 2013:914272. [PMID: 23970821 PMCID: PMC3736457 DOI: 10.1155/2013/914272] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 06/26/2013] [Accepted: 06/26/2013] [Indexed: 01/09/2023] Open
Abstract
The iatrogenic risk of HIV vertical transmission, calculated in initial epidemiologic studies, seemed to counterindicate invasive prenatal diagnosis (PND) procedures. The implementation of highly active antiretroviral therapy (HAART) represented a turning point in PND management, owing to a rapid and effective reduction of maternal viral load (VL). In the present study, we identified cases of vertical transmission in HIV-infected pregnant women who did amniocentesis in the second trimester of pregnancy (n = 27), from 1996 to 2011. We divided our sample into Group A—women under HAART when submitted to amniocentesis (n = 20) and Group B—women without antiretroviral therapy before amniocentesis (n = 7). We had 1 case of vertical transmission in Group B. Preconceptional or early first trimester HIV serology is essential to avoid performing an amniocentesis without antiretroviral therapy or viral suppression. When there is an indication for amniocentesis in an HIV-infected pregnant woman, it should be done if the patient is on HAART and, if possible, when VL is undetectable. Nowadays, with combined first trimester screening test to select pregnancies with high risk of aneuploidies, advanced maternal age is a less frequent indication to perform PND invasive procedures, representing an outstanding gain in prenatal diagnosis of this population.
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25
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Blanche S, Dollfus C, Faye A, Rouzioux C, Mandelbrot L, Tubiana R, Warszawski J. [Pediatric aids, 30 years later]. Arch Pediatr 2013; 20:890-6. [PMID: 23850051 DOI: 10.1016/j.arcped.2013.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 05/29/2013] [Indexed: 12/01/2022]
Abstract
Thirty years after the first descriptions of AIDS in children in May 1983, the risk of viral transmission from mother to child has been reduced to almost zero and the disease in infected children has become an asymptomatic condition, stable in the long-term, thanks to antiretroviral drugs. Unbelievable though it may have seemed until the mid-1990s, children infected during the perinatal period are now growing up to be adults in a chronic, stable, asymptomatic medical condition with often satisfactory personal, family, and social lives. The French perinatal epidemiological cohort, which was set up in 1984 and has included more than 18,000 mother-child pairs to date, traces the steps in this extraordinary revolution in the prevention and treatment of HIV-1 infection in children.
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Affiliation(s)
- S Blanche
- Unité d'immunologie hématologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
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Roth P, Bernard JP, Salomon L, Dumez Y, Ville Y. Prélèvements fœtaux : à propos de quelques situations problématiques. ACTA ACUST UNITED AC 2013; 41:446-52. [PMID: 23876417 DOI: 10.1016/j.gyobfe.2013.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
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27
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11.0 References. HIV Med 2012. [DOI: 10.1111/j.1468-1293.2012.1030_12.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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28
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7.0 Obstetric management. HIV Med 2012. [DOI: 10.1111/j.1468-1293.2012.1030_8.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Taylor GP, Clayden P, Dhar J, Gandhi K, Gilleece Y, Harding K, Hay P, Kennedy J, Low-Beer N, Lyall H, Palfreeman A, Tookey P, Welch S, Wilkins E, de Ruiter A. British HIV Association guidelines for the management of HIV infection in pregnant women 2012. HIV Med 2012. [DOI: 10.1111/j.1468-1293.2012.01030.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- GP Taylor
- Communicable Diseases; Section of Infectious Diseases; Imperial College London; UK
| | - P Clayden
- UK Community Advisory Board representative/HIV treatment advocates network; London; UK
| | - J Dhar
- Genitourinary Medicine; University Hospitals of Leicester NHS Trust; Leicester; UK
| | - K Gandhi
- Heart of England NHS Foundation Trust; Birmingham; UK
| | | | - K Harding
- Guy's and St Thomas′ Hospital NHS Foundation Trust; London; UK
| | - P Hay
- St George's Healthcare NHS Trust; London; UK
| | - J Kennedy
- Homerton University Hospital NHS Foundation Trust; London; UK
| | - N Low-Beer
- Chelsea and Westminster Hospital NHS Foundation Trust; London; UK
| | - H Lyall
- Imperial College Healthcare NHS Trust; London; UK
| | - A Palfreeman
- Genitourinary Medicine; University Hospitals of Leicester NHS Trust; Leicester; UK
| | - P Tookey
- UCL Institute of Child Health; London; UK
| | - S Welch
- Paediatric Infectious Diseases; Heart of England NHS Foundation Trust; Birmingham; UK
| | - E Wilkins
- Infectious Diseases and Director of the HIV Research Unit; North Manchester General Hospital; Manchester; UK
| | - A de Ruiter
- Genitourinary Medicine; Guy's and St Thomas' NHS Foundation Trust; London; UK
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30
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Brown K, Holland B, Mosquera C, Calilap C, Bardeguez A. Human immunodeficiency virus infection in advanced maternal age gravidas. AIDS Res Hum Retroviruses 2012; 28:265-9. [PMID: 21801081 DOI: 10.1089/aid.2010.0365] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Our study compares perinatal outcomes among HIV(+) versus HIV(-) advanced maternal aged (AMA) women. A retrospective cohort study of AMA deliveries from 2000 to 2009 was performed. HIV(+) (group A) women were compared to temporally matched HIV(-) (group B) women. Demographics, medical comorbidities, HIV treatment, and delivery data were collected. SAS was used for data analysis with p<0.05 considered significant. Seventy-one patients per study group were reviewed; for group A, the mean CD4 count near delivery was 507±363; 75% (34/45) had viral load ≤400 in the third trimester and 58% were on a protease inhibitor regimen. HIV(+) women had significantly higher preterm delivery (PTD) <37 weeks (A: 40.85%, B: 16.90%, p=0.0016). Logistic regression performed revealed that the odds of PTD was 2.83 (CI 1.22-6.54) for HIV(+) and 4.02 (CI 1.27-12.72) for drug use independent of other factors. The pathophysiology of PTD among HIV(+) AMA women warrants prospective examination to better define the causal relationship.
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Affiliation(s)
- Kelecia Brown
- Department of Obstetrics, Gynecology and Women's Health, UMDNJ-New Jersey Medical School, Newark, New Jersey
| | - Bart Holland
- Preventative Medicine, UMDNJ-New Jersey Medical School, Newark, New Jersey
| | - Claudia Mosquera
- Department of Obstetrics, Gynecology and Women's Health, UMDNJ-New Jersey Medical School, Newark, New Jersey
| | - Charmane Calilap
- Department of Obstetrics, Gynecology and Women's Health, UMDNJ-New Jersey Medical School, Newark, New Jersey
| | - Arlene Bardeguez
- Department of Obstetrics, Gynecology and Women's Health, UMDNJ-New Jersey Medical School, Newark, New Jersey
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31
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Navér L, Albert J, Belfrage E, Flamholc L, Gisslén M, Gyllensten K, Josephson F, Karlström O, Lindgren S, Pettersson K, Svedhem V, Sönnerborg A, Westling K, Yilmaz A. Prophylaxis and treatment of HIV-1 infection in pregnancy: Swedish Recommendations 2010. ACTA ACUST UNITED AC 2011; 43:411-23. [DOI: 10.3109/00365548.2011.567392] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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32
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Savvidou MD, Samuel I, Syngelaki A, Poulton M, Nicolaides KH. First-trimester markers of aneuploidy in women positive for HIV. BJOG 2010; 118:844-8. [PMID: 21062401 DOI: 10.1111/j.1471-0528.2010.02767.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M D Savvidou
- Department of Maternal Fetal Medicine, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK.
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33
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Reshi P, Lone IM. Human immunodeficiency virus and pregnancy. Arch Gynecol Obstet 2009; 281:781-92. [DOI: 10.1007/s00404-009-1334-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 12/08/2009] [Indexed: 10/20/2022]
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34
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[Amniocentesis and viral risk (hepatitis B, C virus and HIV)]. ACTA ACUST UNITED AC 2009; 38:469-73. [PMID: 19679409 DOI: 10.1016/j.jgyn.2009.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Revised: 06/29/2009] [Accepted: 07/07/2009] [Indexed: 12/16/2022]
Abstract
Very few studies have properly addressed to the risk of fetal hepatitis B (HBV), hepatitis C (HCV) or human immunodeficiency virus (HIV) infection through amniocentesis. For HBV, this risk is low. However, knowledge of the maternal hepatitis B e antigen status is valuable in the counselling of risks associated with amniocentesis. For HCV, the risk is not well known but cannot be excluded. For HIV, it seems rational to propose a viral test before amniocentesis for patients with contamination's risk and to postpone the sampling in cases with positive results in order to obtain an undetectable HIV-1 RNA viral load. For these reasons, it can be useful to analyse for each virus the benefit of amniocentesis and the risk of mother-to-infant transmission, and to inform the patient.
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35
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Transmisión vertical del virus de la inmunodeficiencia humana en la era del tratamiento antirretroviral de gran actividad. Med Clin (Barc) 2009; 132:505-6. [DOI: 10.1016/j.medcli.2008.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 12/16/2008] [Indexed: 11/22/2022]
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