HIV and Maternal Mortality: Intersecting Epidemics
1
RETHINKING THE ETIOLOGIES OF MATERNAL MORTALITY: A RETROSPECTIVE COHORT STUDY INVESTIGATING THE ASSOCIATION BETWEEN HIV STATUS AND SEVERE OBSTETRIC HEMORRHAGE IN ZAMBIA • Despite a global effort to curb maternal mortality, nearly 275,000 women continue to die in childbirth annually. 1 • Recent global health literature implicates HIV as a major etiology of maternal death with an estimated 56,100 HIV-related deaths during pregnancy per year, however little is known regarding the mechanism through which HIV impacts maternal health. 1 • The results from this analysis suggest that among women experiencing obstetric hemorrhage, HIV positive women had nearly two fold odds of severe obstetric hemorrhage when compared to HIV negative women. HIV and Maternal Mortality: Intersecting Epidemics Acknowledgements: This project was undertaken as the fieldwork component of an MS in Global Health Sciences at UCSF. Special thanks to entire NASG research team at UCSF’s Safe Motherhood Program who provided study data as well as invaluable advice and guidance. Warm thanks to the Zambian nurses/data collectors, without whom this study would not have been possible. Authors: Megan Rose Curtis 1 , Alison El Ayadi 2 , Gricelia Mkumba 3 , Elizabeth Butrick 2 , Ashley Leech 4 , Jillian Gei Suellen Miller 2 • We estimated logistic regression models to explore the relationship between HIV status and severe obstetric hemorrhage, defined as blood loss equal to or greater than 1000 mL. OVERVIEW MOTIVATION AND METHODS Global Progress Towards Reducing Maternal Deaths BACKGROUND • The sample comprised 321 women admitted to one of three tertiary care facilities in Zambia between September 2010 - March 2012 with two of the following three eligibility criteria: • Pulse > 100bpm • Blood pressure < 100mmHg • Estimated blood loss ≥ 1000 mL RESULTS Multivariable logistic regression of HIV and other predictors on severe obstetric hemorrhage* Participant demographics, N=321 DISCUSSION Implications • Suggests HIV may increase severity of obstetric hemorrhage, thus increasing a woman’s risk of maternal mortality. • This study should encourage further research into the ways in which HIV infection operates to impact maternal health. Limitations • Overlap between eligibility criteria and outcome variable. • Subjectivity of estimated blood loss. • 52% of original sample excluded due to missing variables or clinical differences. • Statistically significant differences in parity between exposure groups. * * * HIV + n=59 HIV – n=262 P-Value Mean age 27.47 S.D.=6.0 0 28.23 S.D.=7.15 0.45 Mean parity 2.19 S.D.=1.7 0 2.82 S.D.=2.31 0.05 Mean gestational age 31.82 S.D.=9.5 7 33.38 S.D.=8.33 0.22 Condition on entry: Normal 19% 25% 0.29 Confused 75% 71% 0.58 Unconscious 5% 2% 0.24 Under anesthesia 2% 2% 0.93 Site: Lusaka 65% 60% 0.56 Kitwe 20% 25% 0.43 Variable included in final model * Variabl e Odds Ratio 95% Confidence Interval P-value HIV status 1.92 1.05 - 3.50 .033 1. Tulane University School of Medicine 2. Safe Motherhood Program, Bixby Center for Global Reproductive Health, University of California San Francisco. 3.University of Zambia, Lusaka. 4. Boston University *multivariable model controlled for parity, age, and site. References : 1. R Lozano, HWang, KJ Foreman. Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet, 378 (2011), pp. 1138–1161 The Lancet, 2011
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Transcript of HIV and Maternal Mortality: Intersecting Epidemics
RETHINKING THE ETIOLOGIES OF MATERNAL MORTALITY: A RETROSPECTIVE COHORT STUDY INVESTIGATING THE ASSOCIATION
BETWEEN HIV STATUS AND SEVERE OBSTETRIC HEMORRHAGE IN ZAMBIA
• Despite a global effort to curb maternal mortality, nearly 275,000 women continue to die in childbirth annually.1
• Recent global health literature implicates HIV as a major etiology of maternal death with an estimated 56,100 HIV-related deaths during pregnancy per year, however little is known regarding the mechanism through which HIV impacts maternal health.1
• The results from this analysis suggest that among women experiencing obstetric hemorrhage, HIV positive women had nearly two fold odds of severe obstetric hemorrhage when compared to HIV negative women.
HIV and Maternal Mortality: Intersecting Epidemics
Acknowledgements: This project was undertaken as the fieldwork component of an MS in Global Health Sciences at UCSF. Special thanks to entire NASG research team at UCSF’s Safe Motherhood Program who provided study data as well as invaluable advice and guidance. Warm thanks to the Zambian nurses/data collectors, without whom this study would not have been possible.
Authors: Megan Rose Curtis1, Alison El Ayadi2, Gricelia Mkumba3, Elizabeth Butrick2, Ashley Leech4, Jillian Geissler2, Suellen Miller2
• We estimated logistic regression models to explore the relationship between HIV status and severe obstetric hemorrhage, defined as blood loss equal to or greater than 1000 mL.
OVERVIEW MOTIVATION AND METHODS
Global Progress Towards Reducing Maternal Deaths
BACKGROUND
• The sample comprised 321 women admitted to one of three tertiary care facilities in Zambia between September 2010 - March 2012 with two of the following three eligibility criteria:
• Pulse > 100bpm• Blood pressure < 100mmHg• Estimated blood loss ≥ 1000 mL
RESULTSMultivariable logistic regression of HIV and other predictors on severe obstetric hemorrhage*
Participant demographics, N=321
DISCUSSION
Implications• Suggests HIV may increase severity of obstetric
hemorrhage, thus increasing a woman’s risk of maternal mortality.
• This study should encourage further research into the ways in which HIV infection operates to impact maternal health.
Limitations• Overlap between eligibility criteria and outcome
variable.• Subjectivity of estimated blood loss.• 52% of original sample excluded due to missing
variables or clinical differences.• Statistically significant differences in parity between
exposure groups.
**
*
HIV +n=59
HIV –n=262
P-Value
Mean age 27.47S.D.=6.00
28.23S.D.=7.15
0.45
Mean parity 2.19S.D.=1.70
2.82S.D.=2.31
0.05
Mean gestational age
31.82S.D.=9.57
33.38S.D.=8.33
0.22
Condition on entry:
Normal 19% 25% 0.29
Confused 75% 71% 0.58
Unconscious 5% 2% 0.24
Under anesthesia 2% 2% 0.93
Site:
Lusaka 65% 60% 0.56
Kitwe 20% 25% 0.43
Ndola 15% 15% 0.88
Variable included in final model *
Variable Odds Ratio 95% Confidence Interval
P-value
HIV status
1.92 1.05 - 3.50 .033
1. Tulane University School of Medicine 2. Safe Motherhood Program, Bixby Center for Global Reproductive Health, University of California San Francisco. 3.University of Zambia, Lusaka. 4. Boston University
*multivariable model controlled for parity, age, and site.
References : 1. R Lozano, HWang, KJ Foreman. Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet, 378 (2011), pp. 1138–1161
The Lancet, 2011
