AIDS-related mortality has declined by 56% among women and girls since 2010.[2]UNAIDS. UNAIDS data 2023. Oct 2023 [internet publication].
https://www.unaids.org/en/resources/documents/2023/2023_unaids_data
The disease status of women with human immunodeficiency virus (HIV) infection in pregnancy does not differ significantly from the prognosis for women with HIV outside of pregnancy. Pregnancies complicated by HIV are more complicated than their HIV-negative counterparts, however. Women with HIV have persistently higher rates of obstetric and postnatal morbidity such as elevated rates of caesarean delivery, preterm premature rupture of membranes, spontaneous preterm delivery, endometritis, and intensive care unit admission.[10]Louis J, Landon MB, Gersnoviez RJ, et al. Perioperative morbidity and mortality among human immunodeficiency virus infected women undergoing cesarean delivery. Obstet Gynecol. 2007 Aug;110(2 Pt 1):385-90.
http://www.ncbi.nlm.nih.gov/pubmed/17666615?tool=bestpractice.com
[11]Haeri S, Shauer M, Dale M, et al. Obstetric and newborn infant outcomes in human immunodeficiency virus-infected women who receive highly active antiretroviral therapy. Am J Obstet Gynecol. 2009 Sep;201(3):315.e1-5.
http://www.ncbi.nlm.nih.gov/pubmed/19733286?tool=bestpractice.com
[12]Suy A, Martínez E, Coll O, et al. Increased risk of pre-eclampsia and fetal death in HIV-infected pregnant women receiving highly active antiretroviral therapy. AIDS. 2006 Jan 2;20(1):59-66.
http://www.ncbi.nlm.nih.gov/pubmed/16327320?tool=bestpractice.com
[13]Parikh L, Timofeev J, Singh J, et al. Racial disparities in maternal and neonatal outcomes in HIV-1 positive mothers. Am J Perinatol. 2014 Jun;31(6):513-20.
http://www.ncbi.nlm.nih.gov/pubmed/24000110?tool=bestpractice.com
Post-caesarean complications have decreased dramatically in the US from 210.6/1000 from 1995 to 1996 to 116.6/1000 in 2010 to 2011; however, rates of infection, surgical trauma, hospital deaths, and prolonged hospitalisation remain significantly higher than in HIV-uninfected women.[14]Kourtis AP, Ellington S, Pazol K, et al. Complications of cesarean deliveries among HIV-infected women in the United States. AIDS. 2014 Nov 13;28(17):2609-18.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509679
http://www.ncbi.nlm.nih.gov/pubmed/25574961?tool=bestpractice.com
In addition, multiple studies suggest that neonates born to women with HIV are at increased risk for complications such as prematurity and being small for gestational age, among others.[7]Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States. Jan 2024 [internet publication].
https://clinicalinfo.hiv.gov/en/guidelines/perinatal/whats-new?view=full
[11]Haeri S, Shauer M, Dale M, et al. Obstetric and newborn infant outcomes in human immunodeficiency virus-infected women who receive highly active antiretroviral therapy. Am J Obstet Gynecol. 2009 Sep;201(3):315.e1-5.
http://www.ncbi.nlm.nih.gov/pubmed/19733286?tool=bestpractice.com
With physical recovery after delivery, the stresses and demands of caring for a new baby, and the risk of postnatal depression, mothers with HIV are particularly vulnerable to problems with adherence to antiretroviral therapy. Support and attention to this issue is warranted.