Background: Stillbirth (SB) has multifactorial and incompletely understood causes. We aimed to assess the SB rate and associated risk factors in HIV-infected women delivering in UK/Ireland between 2007-2015.
Methods: We analysed data from singleton deliveries and defined a SB as a baby delivered at ≥24 gestational weeks (GW) showing no signs of life. We performed multivariable logistic regression of SB risk factors, adjusted for maternal age and country of origin (grouped, see Table), year, IDU history, parity, first antenatal CD4 count ≤350cells/µL, antenatal ART regimen, late antenatal care start (≥13GW) and newborn gender with random effect for repeated pregnancies in the same mother.
Results: There were 10157 pregnancies (in 7951 mothers) and 87 (0.9%) SB; MTCT was reported in 41 (0.4%) cases. Compared to live births (LB) SB were more likely to be male (58.7% vs 50.6%), delivered pre-term (median 33.5GW vs 39GW) and be SGA (55.2% vs 20.4%); 7/87 (8.1%) SB had congenital abnormalities versus 295/10070 (2.9%) LB. Compared to mothers delivering a LB, those delivering a SB were more likely to be primiparous (46.5% vs 32.7%), older (56.3% vs 47.2% of age ≥33yrs), from Eastern Africa (47.1% vs 41.4%), more likely to book antenatal care at ≥13GW (93.1% vs 86.8%), have first antenatal CD4 count ≤350cells/µL (50.8% vs 34.5%) and more likely to receive no antenatal ART (5.8% vs 1.6%). Multivariate analysis suggested that significant risk factors associated with SB were antenatal CD4 count ≤350cells/µL and delivering a male newborn; women whose country of origin was not Europe or Africa were also at higher risk (Table).

Maternal age (per 1year increase)1.04 (0.98, 1.10)
Area of origin: Europe1.00
Eastern Africa1.63 (0.55, 4.80)
Western Africa1.35 (0.40, 4.57)
Middle/South Africa2.24 (0.68, 7.39)
Other4.33 (1.31, 14.26)
CD4 cells/µL: ≤3501.00
>3501.96 (1.09, 3.53)
Newborn : Female1.00
Male1.95 (1.06, 3.58)
[Adjusted OR (95%CI) for stillbirth]

Conclusions: SB rate in HIV-infected women in UK/Ireland was 0.9% in 2007-2015, around twice that in the general population (< 0.5%). Further research is needed to understand circumstances around SB in this population in order to identify possible interventions.

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