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Article(id=1241322669363221136, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241322661654098823, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202309172, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1694102400000, receivedDateStr=2023-09-08, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773883987036, onlineDateStr=2026-03-19, pubDate=1706112000000, pubDateStr=2024-01-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773883987036, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773883987036, creator=13701087609, updateTime=1773883987036, updator=13701087609, issue=Issue{id=1241322661654098823, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='2', pageStart='193', pageEnd='384', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773883985198, creator=13701087609, updateTime=1773890256678, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241348966214849502, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241322661654098823, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241348966214849503, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241322661654098823, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=266, endPage=272, ext={EN=ArticleExt(id=1241322670294356685, articleId=1241322669363221136, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Occurrence and influencing factors of adverse birth outcomes in AIDS-infected pregnant women, Anhui, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To describe the incidence of adverse birth outcomes in AIDS-infected parturients in Anhui province, and to analyze the effects of antiretroviral treatment, complications during pregnancy, and other socio-demographic factors on adverse birth outcomes.

Methods

Information of all HIV-infected mothers and their newborns in Anhui province from 2011 to 2023 was collected from the National Direct Reporting Information System for the Prevention of mother-to-child transmission of AIDS, Syphilis, and Hepatitis B. The risk factors of adverse birth outcomes among HIV-infected mothers were analyzed by Chi-square test and multiple logistic regression analysis.

Results

In Anhui Province, the incidence of at least one adverse birth outcome, preterm birth, low birth weight, stillbirth/neonatal death, and birth defect was 13.9%, 9.0%, 8.2%, 2.6%, and 0.3%, respectively. The risk of total adverse birth outcomes was higher in AIDS-infected women with higher education (OR=2.770, 95% CI: 1.043-7.354), farmers (OR=2.877, 95% CI: 1.454-5.692), and moderate to severe anemia (OR=4.053, 95% CI: 1.411-11.643). Higher education level (OR=3.815, 95% CI: 1.145-12.705), occupation as a farmer (OR=2.763, 95% CI: 1.228-6.218), pregnancy combined with diabetes (OR=2.546, 95% CI: 1.025-6.325) promoted premature birth; The risk of low birth weight was higher in farmers (OR=2.626, 95% CI: 1.108-6.224), taking anti-HIV drugs (OR=12.949, 95% CI: 1.209-138.725), moderate to severe anemia (OR=4.281, 95% CI: 1.288-14.224) and pregnancy-induced hypertension (OR=4.880, 95% CI: 1.207-19.735). First marriage/divorce/widowhood (OR=0.264, 95% CI: 0.108-0.646) was associated with a lower risk of low birth weight than unmarried/cohabiting individuals. The effect of syphilis in pregnancy on stillbirth/neonatal death was statistically significant (OR=32.795, 95% CI: 1.178-913.003).

Conclusion

Further interventions are needed to improve pregnancy outcomes for women living with HIV.

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目的

描述安徽省艾滋病感染产妇不良出生结局的发生情况，分析艾滋病抗逆转录病毒治疗、妊娠期合并症及其他社会人口统计学因素等对不良出生结局的影响。

方法

从“国家预防艾滋病、梅毒和乙肝母婴传播直报信息系统”中收集2004—2023年安徽省所有艾滋病感染产妇及所生新生儿信息，对艾滋病感染产妇不良出生结局的影响因素进行χ2检验和多因素logistic回归分析。

结果

安徽省艾滋病感染产妇至少发生一种不良出生结局、早产、低出生体重、死胎死产/新生儿死亡、出生缺陷发生率分别为13.9%、9.0%、8.2%、2.6%、0.3%。文化程度更高（OR=2.770，95% CI：1.043~7.354）、职业为农民（OR=2.877，95% CI：1.454~5.692）、有中重度贫血（OR=4.053，95% CI：1.411~11.643）的艾滋病感染产妇总不良出生结局发生的风险更高；较高文化程度（OR=3.815，95% CI：1.145~12.705）、职业为农民（OR=2.763，95% CI：1.228~6.218）、妊娠合并糖尿病（OR=2.546，95% CI：1.025~6.325）促进早产发生；职业为农民（OR=2.626，95% CI：1.108~6.224）、服用抗艾滋病病毒药物（OR=12.949，95% CI：1.209~138.725）、有中重度贫血（OR=4.281，95% CI：1.288~14.224）和妊娠高血压疾病者（OR=4.880，95% CI：1.207~19.735）低出生体重发生的风险更高，与未婚/同居相比，初婚/离婚/丧偶者（OR=0.264，95% CI：0.108~0.646）低出生体重发生的风险更低；妊娠梅毒（OR=32.795，95% CI：1.178~913.003）对死胎死产/新生儿死亡的影响具有统计学意义。

结论

需要采取进一步干预措施，改善感染艾滋病毒妇女的妊娠结局。

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张悦，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=oUDspdTjnPS+/O+PPa2SJA==, magXml=Yvf7Or8Zt67bsLD3VmOf/w==, pdfUrl=null, pdf=cjLgxcT4v96OKthRVFpN9w==, pdfFileSize=599017, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=EEPgnfkzzwpv+AGdDeqHpQ==, mapNumber=null, authorCompany=null, fund=null, authors=

张悦（1989—），女，硕士，主治医师，研究方向：妇幼保健

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张悦（1989—），女，硕士，主治医师，研究方向：妇幼保健

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AIDS, 2020, 34(11): 1643-1656., articleTitle=Adverse perinatal outcomes associated with antiretroviral therapy regimens: systematic review and network meta-analysis, refAbstract=null), Reference(id=1241322683506414062, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322669363221136, doi=null, pmid=null, pmcid=null, year=2018, volume=79, issue=1, pageStart=1, pageEnd=9, url=null, language=null, rfNumber=[25], rfOrder=26, authorNames=Saleska JL, Turner AN, Maierhofer C, journalName=Journal of Acquired Immune Deficiency Syndromes, refType=null, unstructuredReference=Saleska JL, Turner AN, Maierhofer C, et al. Use of antiretroviral therapy during pregnancy and adverse birth outcomes among women living with HIV-1 in Low- and Middle-Income countries: a systematic review[J]. Journal of Acquired Immune Deficiency Syndromes, 2018, 79(1): 1-9., articleTitle=Use of antiretroviral therapy during pregnancy and adverse birth outcomes among women living with HIV-1 in Low- and Middle-Income countries: a systematic review, refAbstract=null), Reference(id=1241322683628048885, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322669363221136, doi=null, pmid=null, pmcid=null, year=2021, volume=28, issue=2, pageStart=10, pageEnd=11, 20, url=null, language=null, rfNumber=[26], rfOrder=27, authorNames=中华人民共和国卫生健康委员会, journalName=中国实用乡村医生杂志, refType=null, unstructuredReference=中华人民共和国卫生健康委员会．预防艾滋病、梅毒和乙肝母婴传播工作规范（2020年版）[J]．中国实用乡村医生杂志，2021，28（2）：10-11, 20., articleTitle=预防艾滋病、梅毒和乙肝母婴传播工作规范（2020年版）, refAbstract=null), Reference(id=1241322683745489407, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322669363221136, doi=null, pmid=null, pmcid=null, year=2021, volume=28, issue=2, pageStart=10, pageEnd=11, 20, url=null, language=null, rfNumber=[26], rfOrder=28, authorNames=National Health Commission of the People’s Republic ofChina, journalName=Chinese Practical Journal of Rural Doctor, refType=null, unstructuredReference=National Health Commission of the People’s Republic ofChina. Code of practice for prevention of mother-to-child transmission of HIV, syphilis and hepatitis B (2020 edition)[J]. Chinese Practical Journal of Rural Doctor, 2021, 28(2): 10-11, 20., articleTitle=Code of practice for prevention of mother-to-child transmission of HIV, syphilis and hepatitis B (2020 edition), refAbstract=null), Reference(id=1241322683951010313, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322669363221136, doi=null, pmid=null, pmcid=null, year=2019, volume=81, issue=5, pageStart=e135, pageEnd=e140, url=null, language=null, rfNumber=[27], rfOrder=29, authorNames=Shava E, Moyo S, Zash R, journalName=Journal of Acquired Immune Deficiency Syndromes, refType=null, unstructuredReference=Shava E, Moyo S, Zash R, et al. Brief report: high rates of adverse birth outcomes in HIV and syphilis coinfected women inBotswana[J]. Journal of Acquired Immune Deficiency Syndromes, 2019, 81(5): e135-e140., articleTitle=Brief report: high rates of adverse birth outcomes in HIV and syphilis coinfected women inBotswana, refAbstract=null), Reference(id=1241322684055867919, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322669363221136, doi=null, pmid=null, pmcid=null, year=2018, volume=33, issue=47, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[28], rfOrder=30, authorNames=Choi H, Kim MH, Lee SJ, journalName=Journal of Korean Medical Science, refType=null, unstructuredReference=Choi H, Kim MH, Lee SJ, et al. Pregnancy rates and outcomes of HIV-Infected women in Korea[J]. Journal of Korean Medical Science, 2018, 33(47): e296., articleTitle=Pregnancy rates and outcomes of HIV-Infected women in Korea, refAbstract=null)], funds=[Fund(id=1241322678578106579, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322669363221136, awardId=AHWJ2021b017, language=CN, fundingSource=2021年度安徽省卫生健康委科研项目(AHWJ2021b017), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241322673012265800, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322669363221136, xref=null, ext=[AuthorCompanyExt(id=1241322673029043017, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322669363221136, companyId=1241322673012265800, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Anhui Women and Children Medical Care Center, Hefei, Anhui 230001, China), AuthorCompanyExt(id=1241322673045820234, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322669363221136, companyId=1241322673012265800, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=安徽省妇女儿童保健中心， 安徽 合肥 230061)])], figs=[ArticleFig(id=1241322678066401445, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322669363221136, language=EN, label=Table 1, caption=

Adverse birth outcomes of AIDS-infected parturients with different characteristics [n (%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
特征艾滋病感染产妇总不良出生结局早产低出生体重死胎死产/新生儿死亡
年龄（岁）
<25242（30.5）35（14.5）23（9.5）21（8.9）7（2.9）
25～35408（51.5）51（12.5）32（7.8）34（8.5）7（1.7）
>35141（17.8）23（16.3）15（10.6）10（7.2）7（5.0）
文化程度
小学及以下308（38.8）40（13.0）22（7.1）23（7.7）10（3.3）
初中328（41.4）47（14.3）33（10.1）26（8.1）9（2.7）
高中及以上141（17.8）20（14.2）14（9.9）14（10.1）2（1.4）
职业
家务/待业/学生321（40.5）41（12.8）31（9.7）26（8.2）5（1.6）
农民265（33.4）41（15.5）23（8.7）22（8.5）11（4.2）
其他172（21.7）22（12.8）14（8.1）13（7.8）4（2.3）
婚姻状况
未婚/同居123（15.5）25（20.3）12（9.8）18（15.0）a7（5.7）
初婚/离婚/丧偶494（62.3）60（12.1）44（8.9）32（6.6）11（2.2）
再婚176（22.2）25（14.2）15（8.5）15（8.6）3（1.7）
孕次（次）
1220（27.7）27（12.3）16（7.3）18（8.3）5（2.3）
2256（32.3）40（15.6）29（11.3）24（9.6）4（1.6）
≥3317（40.0）43（13.6）26（8.2）23（7.4）12（3.8）
产次（次）
初产妇302（38.1）38（12.6）25（8.3）25（8.4）6（2.0）
经产妇491（61.9）72（14.7）46（9.4）40（8.4）15（3.1）
本次妊娠前是否已知HIV感染
否220（27.7）32（14.5）21（9.5）19（8.8）5（2.3）
是326（41.1）44（13.5）32（9.8）28（8.7）7（2.1）
抗艾滋病病毒药物应用
未用药179（22.6）26（14.5）19（10.6）14（8.2）7（4.0）
用药611（77.0）83（13.6）52（8.5）51（8.4）13（2.1）
开始用药时间
未用药182（23.0）27（14.8）19（10.4）14（8.2）8（4.4）
产时/产后68（8.6）9（13.2）6（8.8）3（4.6）3（4.4）
孕期484（61.0）66（13.6）40（8.3）42（8.7）10（2.1）
孕前59（7.4）8（13.6）6（10.2）6（10.2）0（0）
用药方案
未用药250（31.5）36（14.4）25（10.0）17（7.2）11（4.4）
TDF+3TC+LPV/r108（13.6）18（16.7）11（10.2）15（13.9）2（1.9）
TDF+3TC+EFV56（7.1）5（8.9）3（5.4）2（3.6）1（1.8）
AZT+3TC+LPV/r183（23.1）26（14.2）19（10.4）17（9.3）3（1.6）
其他方案196（24.7）25（12.8）13（6.6）14（7.2）4（2.0）
孕期随访次数（次）
0203（25.6）28（13.8）20（9.9）15（7.7）7（3.5）
1～4247（31.1）35（14.2）20（8.1）20（8.2）8（3.2）
≥5337（42.5）44（13.1）28（8.3）29（8.7）5（1.5）
中重度贫血
否752（94.8）99（13.2）a68（9.0）56（7.6）a18（2.4）
是41（5.2）11（26.8）3（7.3）9（22.5）3（7.3）
妊娠高血压疾病
否776（97.9）105（13.5）67（8.6）61（8.0）20（2.6）
是17（2.1）5（29.4）4（23.5）4（23.5）1（5.9）
妊娠合并糖尿病
否716（90.3）93（13.0）a56（7.8）a53（7.6）a18（2.5）
是77（9.7）17（22.1）15（19.5）12（15.6）3（3.9）
妊娠合并肝病
否773（97.5）106（13.7）69（8.9）61（8.1）21（2.7）
是20（2.5）4（20.0）2（10.0）4（20.0）0（0）
妊娠梅毒
否771（97.2）108（14.0）70（9.1）65（8.6）19（2.5）
是22（2.8）2（9.1）1（4.5）0（0）2（9.1）
), ArticleFig(id=1241322678162870446, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322669363221136, language=CN, label=表1, caption=

不同特征艾滋病感染产妇发生不良出生结局情况 [n（%）]

, figureFileSmall=null, figureFileBig=null, tableContent=
特征艾滋病感染产妇总不良出生结局早产低出生体重死胎死产/新生儿死亡
年龄（岁）
<25242（30.5）35（14.5）23（9.5）21（8.9）7（2.9）
25～35408（51.5）51（12.5）32（7.8）34（8.5）7（1.7）
>35141（17.8）23（16.3）15（10.6）10（7.2）7（5.0）
文化程度
小学及以下308（38.8）40（13.0）22（7.1）23（7.7）10（3.3）
初中328（41.4）47（14.3）33（10.1）26（8.1）9（2.7）
高中及以上141（17.8）20（14.2）14（9.9）14（10.1）2（1.4）
职业
家务/待业/学生321（40.5）41（12.8）31（9.7）26（8.2）5（1.6）
农民265（33.4）41（15.5）23（8.7）22（8.5）11（4.2）
其他172（21.7）22（12.8）14（8.1）13（7.8）4（2.3）
婚姻状况
未婚/同居123（15.5）25（20.3）12（9.8）18（15.0）a7（5.7）
初婚/离婚/丧偶494（62.3）60（12.1）44（8.9）32（6.6）11（2.2）
再婚176（22.2）25（14.2）15（8.5）15（8.6）3（1.7）
孕次（次）
1220（27.7）27（12.3）16（7.3）18（8.3）5（2.3）
2256（32.3）40（15.6）29（11.3）24（9.6）4（1.6）
≥3317（40.0）43（13.6）26（8.2）23（7.4）12（3.8）
产次（次）
初产妇302（38.1）38（12.6）25（8.3）25（8.4）6（2.0）
经产妇491（61.9）72（14.7）46（9.4）40（8.4）15（3.1）
本次妊娠前是否已知HIV感染
否220（27.7）32（14.5）21（9.5）19（8.8）5（2.3）
是326（41.1）44（13.5）32（9.8）28（8.7）7（2.1）
抗艾滋病病毒药物应用
未用药179（22.6）26（14.5）19（10.6）14（8.2）7（4.0）
用药611（77.0）83（13.6）52（8.5）51（8.4）13（2.1）
开始用药时间
未用药182（23.0）27（14.8）19（10.4）14（8.2）8（4.4）
产时/产后68（8.6）9（13.2）6（8.8）3（4.6）3（4.4）
孕期484（61.0）66（13.6）40（8.3）42（8.7）10（2.1）
孕前59（7.4）8（13.6）6（10.2）6（10.2）0（0）
用药方案
未用药250（31.5）36（14.4）25（10.0）17（7.2）11（4.4）
TDF+3TC+LPV/r108（13.6）18（16.7）11（10.2）15（13.9）2（1.9）
TDF+3TC+EFV56（7.1）5（8.9）3（5.4）2（3.6）1（1.8）
AZT+3TC+LPV/r183（23.1）26（14.2）19（10.4）17（9.3）3（1.6）
其他方案196（24.7）25（12.8）13（6.6）14（7.2）4（2.0）
孕期随访次数（次）
0203（25.6）28（13.8）20（9.9）15（7.7）7（3.5）
1～4247（31.1）35（14.2）20（8.1）20（8.2）8（3.2）
≥5337（42.5）44（13.1）28（8.3）29（8.7）5（1.5）
中重度贫血
否752（94.8）99（13.2）a68（9.0）56（7.6）a18（2.4）
是41（5.2）11（26.8）3（7.3）9（22.5）3（7.3）
妊娠高血压疾病
否776（97.9）105（13.5）67（8.6）61（8.0）20（2.6）
是17（2.1）5（29.4）4（23.5）4（23.5）1（5.9）
妊娠合并糖尿病
否716（90.3）93（13.0）a56（7.8）a53（7.6）a18（2.5）
是77（9.7）17（22.1）15（19.5）12（15.6）3（3.9）
妊娠合并肝病
否773（97.5）106（13.7）69（8.9）61（8.1）21（2.7）
是20（2.5）4（20.0）2（10.0）4（20.0）0（0）
妊娠梅毒
否771（97.2）108（14.0）70（9.1）65（8.6）19（2.5）
是22（2.8）2（9.1）1（4.5）0（0）2（9.1）
), ArticleFig(id=1241322678301282488, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322669363221136, language=EN, label=Table 2, caption=

Logistic regression analysis of adverse birth outcomes of AIDS-infected women

, figureFileSmall=null, figureFileBig=null, tableContent=
变量b值b值标准误Wald卡方值P值OR（95% CI）
总不良出生结局
文化程度
小学及以下1
初中0.7490.3773.9500.0472.115（1.010~4.429）
高中及以上1.0190.4984.1820.0412.770（1.043~7.354）
职业
家务/待业/学生1
农民1.0570.3489.2100.0022.877（1.454~5.692）
其他0.2340.3730.3920.5311.263（0.608~2.626）
中重度贫血
否1
是1.4000.5386.7580.0094.053（1.411~11.643）
早产
文化程度
小学及以下1
初中1.2260.4716.7820.0093.408（1.354~8.574）
高中及以上1.3390.6144.7570.0293.815（1.145~12.705）
职业
家务/待业/学生1
农民1.0160.4146.0360.0142.763（1.228~6.218）
其他0.1960.4430.1960.6581.217（0.510~2.900）
妊娠合并糖尿病
否1
是0.9340.4644.0490.0442.546（1.025~6.325）
低出生体重
职业
家务/待业/学生1
农民0.9650.4404.8070.0282.626（1.108~6.224）
其他0.3280.4570.5180.4721.389（0.568~3.398）
婚姻状况
未婚/同居1
初婚/离婚/丧偶-1.3300.4568.5040.0040.264（0.108~0.646）
再婚-0.3170.5090.3880.5330.728（0.269~1.975）
抗艾滋病病毒药物应用
未用药1
用药2.5611.2104.4800.03412.949（1.209~138.725）
中重度贫血
否1
是1.4540.6135.6320.0184.281（1.288~14.224）
妊娠高血压疾病
否1
是1.5850.7134.9430.0264.880（1.207~19.735）
死胎死产/新生儿死亡
妊娠梅毒
否1
是3.4901.6974.2290.04032.795（1.178~913.003）
), ArticleFig(id=1241322678422917313, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241322669363221136, language=CN, label=表2, caption=

艾滋病感染产妇不良出生结局的多因素 logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量b值b值标准误Wald卡方值P值OR（95% CI）
总不良出生结局
文化程度
小学及以下1
初中0.7490.3773.9500.0472.115（1.010~4.429）
高中及以上1.0190.4984.1820.0412.770（1.043~7.354）
职业
家务/待业/学生1
农民1.0570.3489.2100.0022.877（1.454~5.692）
其他0.2340.3730.3920.5311.263（0.608~2.626）
中重度贫血
否1
是1.4000.5386.7580.0094.053（1.411~11.643）
早产
文化程度
小学及以下1
初中1.2260.4716.7820.0093.408（1.354~8.574）
高中及以上1.3390.6144.7570.0293.815（1.145~12.705）
职业
家务/待业/学生1
农民1.0160.4146.0360.0142.763（1.228~6.218）
其他0.1960.4430.1960.6581.217（0.510~2.900）
妊娠合并糖尿病
否1
是0.9340.4644.0490.0442.546（1.025~6.325）
低出生体重
职业
家务/待业/学生1
农民0.9650.4404.8070.0282.626（1.108~6.224）
其他0.3280.4570.5180.4721.389（0.568~3.398）
婚姻状况
未婚/同居1
初婚/离婚/丧偶-1.3300.4568.5040.0040.264（0.108~0.646）
再婚-0.3170.5090.3880.5330.728（0.269~1.975）
抗艾滋病病毒药物应用
未用药1
用药2.5611.2104.4800.03412.949（1.209~138.725）
中重度贫血
否1
是1.4540.6135.6320.0184.281（1.288~14.224）
妊娠高血压疾病
否1
是1.5850.7134.9430.0264.880（1.207~19.735）
死胎死产/新生儿死亡
妊娠梅毒
否1
是3.4901.6974.2290.04032.795（1.178~913.003）
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安徽省艾滋病感染产妇不良出生结局情况及影响因素分析
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张悦 , 郭刘闰南 , 黄朝辉 , 胡林凤 , 冯芳 , 刘恺 , 周艳
现代预防医学 | 儿少卫生与妇幼保健 2024,51(2): 266-272
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现代预防医学 | 儿少卫生与妇幼保健 2024, 51(2): 266-272
安徽省艾滋病感染产妇不良出生结局情况及影响因素分析
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张悦 , 郭刘闰南, 黄朝辉, 胡林凤, 冯芳, 刘恺, 周艳
作者信息
  • 安徽省妇女儿童保健中心， 安徽 合肥 230061

    • 张悦（1989—），女，硕士，主治医师，研究方向：妇幼保健

通讯作者:

张悦，E-mail：
Occurrence and influencing factors of adverse birth outcomes in AIDS-infected pregnant women, Anhui
Yue ZHANG , GUO Liu-runnan, Chao-hui HUANG, Lin-feng HU, Fang FENG, Kai LIU, Yan ZHOU
Affiliations
  • Anhui Women and Children Medical Care Center, Hefei, Anhui 230001, China
出版时间: 2024-01-25 doi: 10.20043/j.cnki.MPM.202309172
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摘要
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目的

描述安徽省艾滋病感染产妇不良出生结局的发生情况，分析艾滋病抗逆转录病毒治疗、妊娠期合并症及其他社会人口统计学因素等对不良出生结局的影响。

方法

从“国家预防艾滋病、梅毒和乙肝母婴传播直报信息系统”中收集2004—2023年安徽省所有艾滋病感染产妇及所生新生儿信息，对艾滋病感染产妇不良出生结局的影响因素进行χ2检验和多因素logistic回归分析。

结果

安徽省艾滋病感染产妇至少发生一种不良出生结局、早产、低出生体重、死胎死产/新生儿死亡、出生缺陷发生率分别为13.9%、9.0%、8.2%、2.6%、0.3%。文化程度更高（OR=2.770，95% CI：1.043~7.354）、职业为农民（OR=2.877，95% CI：1.454~5.692）、有中重度贫血（OR=4.053，95% CI：1.411~11.643）的艾滋病感染产妇总不良出生结局发生的风险更高；较高文化程度（OR=3.815，95% CI：1.145~12.705）、职业为农民（OR=2.763，95% CI：1.228~6.218）、妊娠合并糖尿病（OR=2.546，95% CI：1.025~6.325）促进早产发生；职业为农民（OR=2.626，95% CI：1.108~6.224）、服用抗艾滋病病毒药物（OR=12.949，95% CI：1.209~138.725）、有中重度贫血（OR=4.281，95% CI：1.288~14.224）和妊娠高血压疾病者（OR=4.880，95% CI：1.207~19.735）低出生体重发生的风险更高，与未婚/同居相比，初婚/离婚/丧偶者（OR=0.264，95% CI：0.108~0.646）低出生体重发生的风险更低；妊娠梅毒（OR=32.795，95% CI：1.178~913.003）对死胎死产/新生儿死亡的影响具有统计学意义。

结论

需要采取进一步干预措施，改善感染艾滋病毒妇女的妊娠结局。

抗逆转录病毒治疗  /  不良出生结局  /  影响因素
Objective

To describe the incidence of adverse birth outcomes in AIDS-infected parturients in Anhui province, and to analyze the effects of antiretroviral treatment, complications during pregnancy, and other socio-demographic factors on adverse birth outcomes.

Methods

Information of all HIV-infected mothers and their newborns in Anhui province from 2011 to 2023 was collected from the National Direct Reporting Information System for the Prevention of mother-to-child transmission of AIDS, Syphilis, and Hepatitis B. The risk factors of adverse birth outcomes among HIV-infected mothers were analyzed by Chi-square test and multiple logistic regression analysis.

Results

In Anhui Province, the incidence of at least one adverse birth outcome, preterm birth, low birth weight, stillbirth/neonatal death, and birth defect was 13.9%, 9.0%, 8.2%, 2.6%, and 0.3%, respectively. The risk of total adverse birth outcomes was higher in AIDS-infected women with higher education (OR=2.770, 95% CI: 1.043-7.354), farmers (OR=2.877, 95% CI: 1.454-5.692), and moderate to severe anemia (OR=4.053, 95% CI: 1.411-11.643). Higher education level (OR=3.815, 95% CI: 1.145-12.705), occupation as a farmer (OR=2.763, 95% CI: 1.228-6.218), pregnancy combined with diabetes (OR=2.546, 95% CI: 1.025-6.325) promoted premature birth; The risk of low birth weight was higher in farmers (OR=2.626, 95% CI: 1.108-6.224), taking anti-HIV drugs (OR=12.949, 95% CI: 1.209-138.725), moderate to severe anemia (OR=4.281, 95% CI: 1.288-14.224) and pregnancy-induced hypertension (OR=4.880, 95% CI: 1.207-19.735). First marriage/divorce/widowhood (OR=0.264, 95% CI: 0.108-0.646) was associated with a lower risk of low birth weight than unmarried/cohabiting individuals. The effect of syphilis in pregnancy on stillbirth/neonatal death was statistically significant (OR=32.795, 95% CI: 1.178-913.003).

Conclusion

Further interventions are needed to improve pregnancy outcomes for women living with HIV.

Antiretroviral therapy (ART)  /  Adverse birth outcome  /  Influence factor
张悦, 郭刘闰南, 黄朝辉, 胡林凤, 冯芳, 刘恺, 周艳. 安徽省艾滋病感染产妇不良出生结局情况及影响因素分析. 现代预防医学, 2024 , 51 (2) : 266 -272 . DOI: 10.20043/j.cnki.MPM.202309172
Yue ZHANG, GUO Liu-runnan, Chao-hui HUANG, Lin-feng HU, Fang FENG, Kai LIU, Yan ZHOU. Occurrence and influencing factors of adverse birth outcomes in AIDS-infected pregnant women, Anhui[J]. Modern Preventive Medicine, 2024 , 51 (2) : 266 -272 . DOI: 10.20043/j.cnki.MPM.202309172
正文
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每年有超过130多万的HIV-1型感染妇女怀孕[1]。通过扩大检测覆盖面、抗逆转录病毒治疗、安全助产、婴儿预防治疗及合理喂养等综合干预措施，艾滋病毒母婴传播已大大减少。截至2022年底，我国艾滋病母婴传播率从干预前的34.8%下降到3%[2]。除了艾滋病毒母婴传播，在艾滋病毒感染的孕妇中，经常有报告不良出生结局（特别是胎儿死亡、早产、宫内生长受限、胎龄过小和出生体重过低等）。这些也需要受到关注，因为早产可导致不良的健康和发育结果，是全世界5岁以下儿童死亡的主要原因[3]。低出生体重也是低收入地区婴儿死亡率的重要预测指标[4]。小于胎龄儿、低出生体重和早产也会对神经认知行为、慢性呼吸和代谢有长期不良影响[5]。
本文利用我国预防艾滋病、梅毒和乙肝母婴传播直报信息系统数据，了解安徽省艾滋病感染产妇不良出生结局发生情况，分析抗逆转录病毒治疗、妊娠期合并症及其他社会人口统计学因素对不良出生结局的影响，为安徽省制定降低艾滋病感染孕产妇不良出生结局发生的政策提供科学依据。
1　资料与方法
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1.1　资料来源
数据来自2004年10月至2023年6月安徽省16个市上报的所有《国家艾滋病、梅毒和乙肝母婴传播直报信息系统》中的HIV感染孕产妇艾滋病个案登记卡，包括感染孕产妇及所生暴露儿童的信息。纳入标准：孕产妇单胎妊娠且HIV抗体初筛试验和复检试验均为阳性，自愿签订项目知情同意书。排除标准：多胎妊娠、人工终止妊娠、HIV感染状况不确定、重复上报、信息缺失等个案。最终793例个案信息纳入分析。本研究通过了安徽省妇女儿童保健中心医学伦理委员会的批准（AHFY2022012）。
1.2　方法
1.2.1　不良出生结局诊断标准
本研究中总不良出生结局定义为包括以下中的任意一种：（1）早产：怀孕37周前分娩；（2）低出生体重：出生体重<2 500 g；（3）死胎死产：死胎为妊娠20周后胎儿在子宫内死亡；死产为胎儿在娩出过程中死亡，死产是死胎的一种；（4）新生儿死亡：出生后28天内死亡；（5）出生缺陷：助产士在新生儿检查或超声结构筛查中发现的先天性异常。
1.2.2　抗逆转录病毒药物方案
由于世卫组织的建议和中国指南不断更新，本研究中艾滋病毒感染孕妇抗逆转录病毒药物的分类为:（1）未用药；（2）替诺福韦（TDF）+拉米夫定（3TC）+洛匹那韦/利托那韦（LPV/r）；（3）替诺福韦（TDF）+拉米夫定（3TC）+依非韦伦（EFV）；（4）齐多夫定（AZT）+拉米夫定（3TC）+洛匹那韦/利托那韦（LPV/r）；（5）其他方案（单一、二联及三联用药）。
1.2.3　统计学方法
采用SPSS 25.0软件进行统计分析，单因素分析采用χ2或Fisher精确检验，检验标准为0.05，χ2检验差异有统计学意义的变量和一些研究认为有影响的变量全部纳入多因素非条件logistic回归分析。
2　结果
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2.1　安徽省艾滋病感染产妇不良出生结局发生情况
2004年10月至2023年6月，安徽省793例单胎妊娠艾滋病感染产妇中，110例至少发生一种不良出生结局，占13.9%。其中71例早产，65例低出生体重儿，21例死胎死产/新生儿死亡，2例发生出生缺陷。
2.2　不同特征艾滋病感染产妇发生不良出生结局情况
不同特征艾滋病感染产妇发生不良出生结局情况详见表1所列。有中重度贫血和妊娠合并糖尿病的艾滋病感染产妇总不良出生结局发生率更高，有妊娠合并糖尿病的艾滋病感染产妇早产发生率更高，不同婚姻状况、中重度贫血和妊娠合并糖尿病情况艾滋病感染产妇的低出生体重发生率差异具有统计学意义（P<0.05）。
2.3　安徽省艾滋病感染产妇不良出生结局影响因素分析
纳入变量年龄（1-小于25岁；2-25～35岁；3-大于35岁）、文化程度（1-小学及以下；2-初中；3-高中及以上）、职业（1-家务/待业/学生；2-农民；3-其他）、婚姻状况（1-未婚/同居；2-初婚/离婚/丧偶，3-再婚）、孕次（1-1次；2-2次；3-≥3次）、产次（1-初产妇；2-经产妇）、本次妊娠前是否已知HIV感染（0-否；1-是）、抗艾滋病病毒药物应用（0-否；1-是）、开始用药时间（0-未用药；1-产时/产后；2-孕期；3-孕前）、用药方案（0-未用药；1-TDF+3TC+LPV/r；2-TDF+3TC+EFV；3-AZT+3TC+LPV/r；4-其他方案）、孕期随访次数（0-0次；1-1～4次；2-≥5次）、中重度贫血（0-否；1-是）、妊娠高血压疾病（0-否；1-是）、妊娠合并糖尿病（0-否；1-是）、妊娠合并肝病（0-否；1-是）、妊娠梅毒（0-否；1-是）构建多因素logistic回归方程。艾滋病感染产妇不良出生结局的多因素logistic回归分析结果见表2所列。
结果发现：文化程度、职业、中重度贫血对总不良出生结局的影响具有统计学意义，与小学及以下文化程度、家务/待业/学生、无中重度贫血相比，文化程度更高、职业为农民、有中重度贫血的艾滋病感染产妇总不良出生结局发生的风险更高；文化程度、职业、妊娠合并糖尿病对早产的影响具有统计学意义；较高文化程度、职业为农民、妊娠合并糖尿病促进早产发生；职业、婚姻状况、抗艾滋病病毒药物应用、中重度贫血、妊娠高血压疾病对低出生体重的影响具有统计学意义；职业为农民、婚姻状况为未婚/同居、服用抗艾滋病病毒药物、有中重度贫血和妊娠高血压疾病者低出生体重发生的风险更高；妊娠梅毒对死胎死产/新生儿死亡的影响具有统计学意义，有妊娠梅毒的艾滋病感染产妇死胎死产/新生儿死亡发生的风险将近提升31.795倍。
3　讨论
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不同国家和地区报告的HIV感染孕妇不良出生结局发生率有所差异。本研究显示，2004—2023年安徽省艾滋病感染产妇至少一种不良出生结局发生率为13.9%，低于广东省HIV感染孕产妇不良妊娠结局发生率27.78%[6]、高于湖北省13.2%[7]。安徽省艾滋病感染产妇早产发生率为9.0%，高于湖南省7.9%[8]和湖北省3.8%[7]，低于美国一项HIV/AIDS纵向队列研究报告的16%[9]。安徽省艾滋病感染产妇低出生体重发生率为8.2%、均低于2011—2017湖南省HIV感染孕产妇低出生体重发生率9.9%[8]和美国纵向队列研究显示的11%[9]。本研究还报告，安徽省艾滋病感染产妇死胎死产/新生儿死亡2.6%，高于Favarato等人报告的2007—2015年英国和爱尔兰HIV感染孕产妇死产率8.5/‰[10]。造成以上差异的原因可能是不同研究纳入分析标准有所差异，本研究未将流产、暴露儿童感染艾滋病纳入分析。
本研究报告的艾滋病感染孕产妇人群不良出生结局发生率均高于普通孕产妇不良妊娠结局发生率，例如Yang Y等人大数据报告显示，中国和瑞典单胎妊娠产妇早产发生率分别为6.7%、4.5%，中国和瑞典低出生体重发生率分别为4.6%、2.9%。死产总发生率分别为1.1%、0.3%[11]。全国妇幼健康年报报告2022年安徽省孕产妇所生围产儿低出生体重率（3.26%）、新生儿死亡率（1.41/‰）造成差异的原因之一为我省艾滋病感染产妇人群较少导致分母小。
本研究显示，患妊娠高血压疾病的艾滋病感染产妇发生低出生体重的风险更高。蔡敏等人分析也显示，妊娠高血压、传播途径和确认感染时期与HIV感染孕产妇发生不良妊娠结局有关[6]。埃塞俄比亚南部一项回顾性队列研究显示，农村居住地、产前贫血、慢性高血压和先兆子痫是低出生体重的独立危险因素，患有慢性高血压或子痫前期的母亲生低体重儿的几率更高。产妇高血压疾病通过多种途径减轻新生儿体重的机制包括减少子宫胎盘血流量和导致胎盘功能不全[12]。Li等人还发现，高血压与湖南省HIV感染孕妇早产风险增加相关[8]。Bukasa等人基于人群的监测数据分析显示，有妊娠期糖尿病的英国和爱尔兰艾滋病毒感染妇女更容易发生死产、早产和巨大儿[13]。我们的研究也发现妊娠合并糖尿病促进早产发生。
艾滋病毒感染也可能通过易患产科并发症（包括贫血）而增加低出生体重的易感性，而贫血可单独影响出生体重[14]。Li等人发现，中重度贫血与湖南省HIV感染孕妇低出生体重、早产风险增加相关[8]。本研究也发现，中重度贫血对不良出生结局、低出生体重的影响具有统计学意义。美国HIV/AIDS纵向队列研究（PHACS）显示，孕晚期贫血妇女早产的发生率比没有贫血的妇女高2倍[9]，而本研究显示，中重度贫血对早产的影响无统计学意义。
虽然抗逆转录病毒治疗对孕产妇健康和预防围产期艾滋病毒母婴传播至关重要[15]，但在怀孕期间使用抗逆转录病毒治疗可能与不良分娩结果有关。本研究发现，服用抗艾滋病病毒药物者低出生体重发生的风险更高，而一些研究表明，在怀孕期间接受抗逆转录病毒治疗的艾滋病毒感染者出现这些结果的风险低于未接受抗逆转录病毒治疗人群[16]。
开始抗逆转录病毒治疗的时机（受孕前或受孕后）对不良妊娠结局的影响不确定。一些研究表明，在怀孕前接受cART治疗的孕妇比在怀孕后开始抗逆转录病毒治疗的孕妇低出生体重自然流产、早产、死胎、死产或新生儿死亡的发生率更高[17-19]。因为妊娠前长期抗逆转录病毒治疗可导致母体血管灌注不良，影响胎盘生长[20-21]。Wu等人分析发现妊娠早期暴露于抗逆转录病毒药物为湖北省艾滋病感染孕妇不良妊娠结局（APOs）的危险因素，在妊娠早期暴露于抗逆转录病毒药物的艾滋病毒感染孕妇的APOs率高于在妊娠中期和晚期暴露于抗逆转录病毒药物的孕妇[7]。本研究发现，不同治疗开始时间对不良出生结局的影响无统计学意义。两项大型队列研究也未显示抗逆转录病毒治疗的时间（受孕前后）与死产之间存在关联[10,22]。肯尼亚西南部的MOTIVATE试验也发现，在怀孕前后开始抗逆转录病毒治疗的妇女中，APO发生率没有观察到差异[23]。
目前关于孕妇使用不同抗逆转录病毒治疗方案的安全性和有效性的充分数据很少。大多数研究表明，以洛匹那韦/利托那韦为基础的抗逆转录病毒治疗方案会增加早产的风险[24]。一项研究表明，基于蛋白酶抑制剂的抗逆转录病毒治疗方案可能导致LBW和早产[25]。Lockman等人随机对照试验研究发现，与efv为基础的治疗相比，以dtg为基础的抗逆转录病毒治疗新生儿死亡率显著降低[15]。国家卫生健康委印发的2020版预防艾滋病、梅毒和乙肝母婴传播工作规范提出，对于孕期发现艾滋病感染孕产妇，应当立即给予抗病毒治疗，可选择以下三种方案中的任意一种：方案一：TDF+3TC+LPV/r；方案二：TDF+3TC+EFV；方案三：AZT+3TC+LPV/r [26]。本研究分析了不同抗逆转录病毒治疗方案对不良出生结局的影响，结果无统计学意义。
本研究分析还发现，与仅感染艾滋病的孕妇相比，艾滋病毒/梅毒合并感染组死胎死产/新生儿死亡的发生率更高。Shava等人也报告，在艾滋病毒/梅毒合并感染的博茨瓦纳母亲中，早产、死产等不良分娩结局的发生率更高[27]。需要进一步的研究来阐明艾滋病毒和梅毒可能增加不良分娩结局的机制，HIV和梅毒感染对不良出生结局的协同作用机制尚不清楚。Favarato等人研究表明死产的危险因素包括先兆子痫、糖尿病、CD4细胞计数<350细胞/mm3、年龄较大和初产等，接受抗逆转录病毒治疗受孕不会增加风险[10]。本研究也未发现抗逆转录病毒治疗、糖尿病等对死胎死产/新生儿死亡的影响有统计学意义。Li等人也有证据表明，妊娠HBV感染等因素是低出生体重的危险因素[8]，而本次分析未发现HBV感染对不良出生结局的影响。
本研究分析了抗逆转录病毒治疗、妊娠期合并症及其他社会人口统计学因素对不良出生结局的影响，但也有一些局限性。病毒载量和CD4检测信息在项目早期没有广泛收集，缺失值多故没有纳入分析。研究表明，艾滋病毒会显著增加孕妇患不良出生结局的风险[28]，而本研究数据来自于直报系统数据，未纳入HIV阴性对象为对照，不能确定HIV感染等影响因素和不良出生结局的因果关系，需要更多的研究来探索不良出生结局之间的影响因素。
基金
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  • 2021年度安徽省卫生健康委科研项目(AHWJ2021b017)
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参考文献 引证文献
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doi: 10.20043/j.cnki.MPM.202309172
  • 接收时间：2023-09-08
  • 首发时间：2026-03-19
  • 出版时间：2024-01-25
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  • 收稿日期：2023-09-08
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2021年度安徽省卫生健康委科研项目(AHWJ2021b017)
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    安徽省妇女儿童保健中心， 安徽 合肥 230061

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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