HIV/AIDS in mothers of advanced age and adverse pregnancy outcomes

Background: Advanced age and HIV status have been investigated separately for their influence on maternal and infant outcomes. Both have been independently associated with adverse fetal growth outcomes, including low birth weight and preterm birth. However, the impact of the co-occurrence of these factors in relation to birth outcomes remains relatively understudied. Methods: We analyzed the Florida hospital discharge linked to vital records for the years 1998-2007. The study population consisted of women of advanced age (>35 years) who had a singleton birth during the study period (N=244,236). The exposure variable was HIV infection status, while the outcomes of interest were low birth weight, very low birth weight, preterm birth, very preterm birth, and small for gestational age. To approximate relative risks, we used multivariable logistic regression to generate adjusted odds ratios (AOR) and 95% confidence intervals (CI). Results: Mothers of advanced age who were HIV-positive were more likely to be black, multiparous, and unmarried with lower levels of education, inadequate prenatal care, and a higher frequency of pregnancy-related complications (p<0.0001). HIV-positive mothers of advanced age had an elevated risk of having infants of low birth weight (AOR=1.51, 95% CI=1.20-1.91) and small for gestational age (AOR=1.43, 95% CI=1.15-1.78). Conclusions: For women of advanced age, HIV-positivity elevates their risk significantly for adverse birth outcomes. The interplay of these multiple biological factors should be considered by healthcare providers when determining appropriate interconception strategies for women and their families.