Changing trends in pregnancy outcome among HIV-infected women between 1985 and 1997 in two southern French university hospitals A. Bongain a,* , A. Berrebi b,1 , E. Marine ´-Barjoan c,2 , B. Dunais d,2 , M. Thene b,1 , C. Pradier d,2 , J.Y. Gillet a a Service de Gyne ´cologie-Obste ´trique, Reproduction et Me ´decine Fœtale, CHU de Nice-Sophia Antipolis, Ho ˆpital de l’Archet 2, 151, route de Saint-Antoine de Ginestie `re, BP 3079, 06202 Nice Cedex 3, France b Fe ´de ´ration de Gyne ´cologie-Obste ´trique, CHU de Toulouse, Ho ˆpital La Grave, Place Lange, 31052 Toulouse Cedex, France c Re ´seau He ´patite C Co ˆte d’Azur, Fe ´de ´ration des Maladies de l’Appareil Digestif, Fe ´de ´ration des Maladies Transmissibles, CHU de Nice-Sophia Antipolis, Ho ˆpital de l’Archet 2, 151, route de Saint-Antoine de Ginestie `re, BP 3079, 06202 Nice Cedex 3, France d Centre d’Information et de Soins de l’Immunde ´ficience Humaine (CISIH), CHU de Nice-Sophia Antipolis, Ho ˆpital de l’Archet 1, 151, route de Saint-Antoine de Ginestie `re, BP 3079, 06202 Nice Cedex 3, France Received 28 November 2001; accepted 20 February 2002 Abstract Objectives: To analyze risk factors for pregnancy outcome among HIV-infected women before and after introduction of AZT prophylaxis in 1994. Study design: A prospective, two-center observational study conducted from 1 January 1985 to 31 December 1997. Patients: Pregnant HIV-infected women followed in one of the obstetrics units during the study period. Main outcome measures: pregnancy outcome (normal delivery, ectopic pregnancy, spontaneous abortion, voluntary termination of pregnancy (TOP) according to year of pregnancy, age at pregnancy professional status, marital status, ethnic origin, mode of contamination, stage of disease, partner’s human immunodeficiency virus (HIV) status and prior pregnancy. Results: One thousand one hundred and three pregnancies among 937 HIV-infected women were studied. Mean age of patients was 28:1  4:9 years. Pregnancy outcomes were distributed as follows: 473 normal deliveries, 589 TOP, 9 ectopic pregnancies and 32 spontaneous abortions. The proportion of TOP decreased from 59.4% before 1994 to 37.5% from 1994 (P < 0:001). In univariate analysis, mode of transmission, marital status, ethnic origin, partner’s HIV status and prior pregnancy were also significantly correlated with pregnancy outcome. However, after adjustment by logistic regression for each period (before and after 1994), mode of transmission no longer appeared to influence pregnancy outcome. Conclusion: Effective prevention of mother-to-child transmission of HIV infection appears to have influenced HIV-infected women’s decisions on continuing their pregnancy to term. Incidence of voluntary TOP has decreased significantly after introduction of AZT. # 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: HIV-1; Pregnancy; Delivery; Abortion; AZT 1. Introduction Human immunodeficiency virus (HIV) infection was a new disease in 1985 and management of pregnancy varied over time as scientific knowledge progressed. In France, HIV-infected women may opt for voluntary termination of pregnancy (TOP) because of the risk of vertical trans- mission of HIV or choose to carry their pregnancy to term. Women make their decision after receiving current medical information available at the time they consult their physician. We analyzed data on pregnancy outcome in HIV-infected women followed in one of two university hospital units in southern France. The main objective of this study was to assess risk factors influencing pregnancy outcome in HIV-infected women. 2. Patients and methods This is a prospective two-center observational study. The inclusion period ran from 1 January 1985 to 31 December 1997. Inclusion criteria were: HIV-1 infection confirmed by ELISA from 1985 until the first half of 1996, and then by European Journal of Obstetrics & Gynecology and Reproductive Biology 104 (2002) 124–128 * Corresponding author. Tel.: þ33-4-92-03-61-05; fax: þ33-4-92-03-59-49. E-mail address: abongain@hotmail.com (A. Bongain). 1 Tel.: þ33-5-61-77-78-52; fax: þ33-5-61-77-79-31. 2 Tel.: þ33-4-92-03-56-34; fax: þ33-4-92-03-56-27. 0301-2115/02/$ – see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved. PII:S0301-2115(02)00103-3