Miscarriage among women in the United States Women's Interagency HIV Study, 1994–2017

Kristin M. Wall, Lisa B. Haddad, C. Christina Mehta, Elizabeth T. Golub, Lisa Rahangdale, Jodie Dionne-Odom, Roksana Karim, Rodney L. Wright, Howard Minkoff, Mardge Cohen, Seble G. Kassaye, Deborah Cohan, Igho Ofotokun, Susan E. Cohn

Research output: Contribution to journalArticle

Abstract

Background: Relatively little is known about the frequency and factors associated with miscarriage among women living with HIV. Objective: The objective of the study was to evaluate factors associated with miscarriage among women enrolled in the Women's Interagency HIV Study. Study Design: We conducted an analysis of longitudinal data collected from Oct. 1, 1994, to Sept. 30, 2017. Women who attended at least 2 Women's Interagency HIV Study visits and reported pregnancy during follow-up were included. Miscarriage was defined as spontaneous loss of pregnancy before 20 weeks of gestation based on self-report assessed at biannual visits. We modeled the association between demographic, behavioral, and clinical covariates and miscarriage (vs live birth) for women overall and stratified by HIV status using mixed-model logistic regression. Results: Similar proportions of women living with and without HIV experienced miscarriage (37% and 39%, respectively, P =.638). In adjusted analyses, smoking tobacco (adjusted odds ratio, 2.0), alcohol use (adjusted odds ratio, 4.0), and marijuana use (adjusted odds ratio, 2.0) were associated with miscarriage. Among women living with HIV, low HIV viral load (<4 log10 copies/mL) (adjusted odds ratio, 0.5) and protease inhibitor (adjusted odds ratio, 0.4) vs the nonuse of combination antiretroviral therapy use were protective against miscarriage. Conclusion: We did not find an increased odds of miscarriage among women living with HIV compared with uninfected women; however, poorly controlled HIV infection was associated with increased miscarriage risk. Higher miscarriage risk among women exposed to tobacco, alcohol, and marijuana highlight potentially modifiable behaviors. Given previous concern about antiretroviral therapy and adverse pregnancy outcomes, the novel protective association between protease inhibitors compared with non–combination antiretroviral therapy and miscarriage in this study is reassuring.

Original languageEnglish (US)
Pages (from-to)347.e1-347.e13
JournalAmerican Journal of Obstetrics and Gynecology
Volume221
Issue number4
DOIs
StatePublished - Oct 2019

Fingerprint

Spontaneous Abortion
HIV
Odds Ratio
Cannabis
Protease Inhibitors
Pregnancy
Alcohols
Live Birth
Pregnancy Outcome
Viral Load
Self Report
HIV Infections
Tobacco
Therapeutics
Logistic Models
Smoking
Demography

Keywords

  • antiretroviral treatment
  • HIV
  • marijuana
  • miscarriage
  • Women's Interagency HIV Study

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Wall, K. M., Haddad, L. B., Mehta, C. C., Golub, E. T., Rahangdale, L., Dionne-Odom, J., ... Cohn, S. E. (2019). Miscarriage among women in the United States Women's Interagency HIV Study, 1994–2017. American Journal of Obstetrics and Gynecology, 221(4), 347.e1-347.e13. https://doi.org/10.1016/j.ajog.2019.05.034

Miscarriage among women in the United States Women's Interagency HIV Study, 1994–2017. / Wall, Kristin M.; Haddad, Lisa B.; Mehta, C. Christina; Golub, Elizabeth T.; Rahangdale, Lisa; Dionne-Odom, Jodie; Karim, Roksana; Wright, Rodney L.; Minkoff, Howard; Cohen, Mardge; Kassaye, Seble G.; Cohan, Deborah; Ofotokun, Igho; Cohn, Susan E.

In: American Journal of Obstetrics and Gynecology, Vol. 221, No. 4, 10.2019, p. 347.e1-347.e13.

Research output: Contribution to journalArticle

Wall, KM, Haddad, LB, Mehta, CC, Golub, ET, Rahangdale, L, Dionne-Odom, J, Karim, R, Wright, RL, Minkoff, H, Cohen, M, Kassaye, SG, Cohan, D, Ofotokun, I & Cohn, SE 2019, 'Miscarriage among women in the United States Women's Interagency HIV Study, 1994–2017', American Journal of Obstetrics and Gynecology, vol. 221, no. 4, pp. 347.e1-347.e13. https://doi.org/10.1016/j.ajog.2019.05.034
Wall, Kristin M. ; Haddad, Lisa B. ; Mehta, C. Christina ; Golub, Elizabeth T. ; Rahangdale, Lisa ; Dionne-Odom, Jodie ; Karim, Roksana ; Wright, Rodney L. ; Minkoff, Howard ; Cohen, Mardge ; Kassaye, Seble G. ; Cohan, Deborah ; Ofotokun, Igho ; Cohn, Susan E. / Miscarriage among women in the United States Women's Interagency HIV Study, 1994–2017. In: American Journal of Obstetrics and Gynecology. 2019 ; Vol. 221, No. 4. pp. 347.e1-347.e13.
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abstract = "Background: Relatively little is known about the frequency and factors associated with miscarriage among women living with HIV. Objective: The objective of the study was to evaluate factors associated with miscarriage among women enrolled in the Women's Interagency HIV Study. Study Design: We conducted an analysis of longitudinal data collected from Oct. 1, 1994, to Sept. 30, 2017. Women who attended at least 2 Women's Interagency HIV Study visits and reported pregnancy during follow-up were included. Miscarriage was defined as spontaneous loss of pregnancy before 20 weeks of gestation based on self-report assessed at biannual visits. We modeled the association between demographic, behavioral, and clinical covariates and miscarriage (vs live birth) for women overall and stratified by HIV status using mixed-model logistic regression. Results: Similar proportions of women living with and without HIV experienced miscarriage (37{\%} and 39{\%}, respectively, P =.638). In adjusted analyses, smoking tobacco (adjusted odds ratio, 2.0), alcohol use (adjusted odds ratio, 4.0), and marijuana use (adjusted odds ratio, 2.0) were associated with miscarriage. Among women living with HIV, low HIV viral load (<4 log10 copies/mL) (adjusted odds ratio, 0.5) and protease inhibitor (adjusted odds ratio, 0.4) vs the nonuse of combination antiretroviral therapy use were protective against miscarriage. Conclusion: We did not find an increased odds of miscarriage among women living with HIV compared with uninfected women; however, poorly controlled HIV infection was associated with increased miscarriage risk. Higher miscarriage risk among women exposed to tobacco, alcohol, and marijuana highlight potentially modifiable behaviors. Given previous concern about antiretroviral therapy and adverse pregnancy outcomes, the novel protective association between protease inhibitors compared with non–combination antiretroviral therapy and miscarriage in this study is reassuring.",
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