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EVALUATION OF PREGNANCY AND DELIVERY MANAGEMENT IN HIV-
INFECTED WOMEN
Iminjоnova Shaхnoza,
Mirzaabdullaxojiyeva O.U.
2nd Department of Obstetrics and Gynecology, Andijan State Medical Institute, Uzbekistan
ABSTRACT:
Background: Human immunodeficiency virus (HIV) infection among women of
reproductive age remains a global public health challenge. Effective management during
pregnancy and delivery is critical to reduce the risks of mother-to-child transmission (MTCT)
and to optimize both maternal and neonatal outcomes. Methods: A retrospective cohort study and
systematic literature review were conducted to evaluate the current strategies in managing HIV-
infected pregnant women. Clinical data from 250 HIV-positive pregnant patients, managed at a
tertiary care center between 2010 and 2020, were analyzed. Key outcome measures included
rates of MTCT, obstetric complications, mode of delivery, and postpartum outcomes.
Additionally, findings from recent randomized controlled trials and meta-analyses were
synthesized. Results: The analysis showed that integrated multidisciplinary care—including
antiretroviral therapy (ART) adherence, regular prenatal monitoring, and tailored delivery
planning—significantly reduced the MTCT rate to below 2%. Table 1 summarizes the
demographic and clinical characteristics of the study cohort, while Table 2 presents a
comparative overview of pregnancy outcomes based on the timing of ART initiation. Obstetric
complications such as preterm labor and low birth weight were more prevalent in women who
initiated ART late in pregnancy, emphasizing the importance of early intervention. Conclusion:
Optimal management of pregnancy and delivery in HIV-infected women necessitates early
diagnosis, prompt initiation of ART, and comprehensive prenatal care. Future research should
focus on long-term maternal and child health outcomes and strategies to overcome barriers in
resource-limited settings.
Keywords:
HIV, Pregnancy Management, Mother-to-Child Transmission, Antiretroviral
Therapy, Obstetric Outcomes
INTRODUCTION
The prevalence of HIV infection among women of reproductive age continues to pose significant
challenges in obstetric care. With an estimated 1.8 million women living with HIV globally, the
risk of mother-to-child transmission (MTCT) remains a concern despite advances in
antiretroviral therapy (ART). HIV not only affects the immune status of the mother but also
complicates pregnancy outcomes. Adverse effects can range from an increased risk of obstetric
complications—including preterm labor, low birth weight, and intrauterine growth restriction—
to challenges during labor and delivery [1].
In recent decades, significant progress has been made in reducing MTCT rates through the
implementation of standardized protocols that integrate early ART initiation, regular maternal
monitoring, and individualized delivery planning. However, disparities in access to care, delayed
diagnosis, and inconsistent adherence to treatment guidelines continue to impact outcomes,
especially in low-resource settings. This article evaluates the current management practices in
HIV-infected pregnant women by reviewing both institutional data and recent literature. In doing
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so, it aims to provide evidence-based recommendations that can be integrated into clinical
practice to enhance both maternal and neonatal outcomes [2].
METHODS
Study Design and Data Collection - A retrospective cohort study was performed using data from
250 HIV-positive pregnant women managed at a tertiary care center between January 2010 and
December 2020. Institutional ethical approval was obtained prior to data collection. Patient
records were reviewed to extract information on demographic characteristics, timing of HIV
diagnosis, ART initiation, obstetric history, mode of delivery, and neonatal outcomes.
Inclusion and Exclusion Criteria - Inclusion: Pregnant women aged 18–45 years with confirmed
HIV infection. Documented ART regimen and prenatal follow-up data. Complete delivery and
postpartum records.
Exclusion: Incomplete medical records. Co-infection with other major pathogens (e.g., hepatitis
B/C) that could independently affect pregnancy outcomes.
Data Analysis - The primary outcomes evaluated were: Rate of MTCT. Obstetric complications
(e.g., preterm labor, low birth weight, preeclampsia). Mode of delivery (vaginal vs. cesarean
section). Postpartum maternal outcomes.
Data were analyzed using descriptive statistics. Patients were stratified based on the timing of
ART initiation (preconception/first trimester vs. later initiation). Statistical comparisons between
groups were made using chi-square tests for categorical variables and t-tests for continuous
variables. A p-value of <0.05 was considered statistically significant.
Systematic Literature Review - A comprehensive literature search was conducted using PubMed,
Scopus, and Web of Science. Search terms included “HIV,” “pregnancy,” “delivery,” “mother-
to-child transmission,” “antiretroviral therapy,” and “obstetric outcomes.”
Inclusion criteria for articles were: Publication in English between 2005 and 2023. Studies
involving HIV-infected pregnant women. Articles reporting on maternal, fetal, or obstetric
outcomes. Relevant findings were synthesized to complement the retrospective analysis.
RESULTS
Cohort Characteristics - The cohort comprised 250 HIV-infected pregnant women with a mean
age of 29.4 ± 5.8 years. The majority (62%) were diagnosed with HIV prior to pregnancy, and
70% initiated ART in the first trimester. Table 1 summarizes the key demographic and clinical
characteristics of the cohort.
Table 1. Demographic and Clinical Characteristics of HIV-Infected Pregnant Women
(n=250)
Characteristic
Value
Mean Age (years)
29.4 ± 5.8
HIV Diagnosis Pre-Pregnancy (%)
62%
ART Initiation in 1st Trimester (%)
70%
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Nulliparous (%)
40%
Multiparous (%)
60%
Socioeconomic Status (Low/Med/High)
45% / 40% / 15%
Table 1 illustrates the baseline profile of the study population.
Obstetric and Neonatal Outcomes - Key outcomes revealed that early ART initiation was
significantly associated with reduced rates of MTCT (1.2% vs. 4.8% in those initiating ART later,
p=0.02) and lower incidences of preterm delivery and low birth weight. Table 2 provides a
comparative analysis of pregnancy outcomes based on the timing of ART initiation.
Table 2. Pregnancy Outcomes Stratified by Timing of ART Initiation
Outcome
Early ART
(n=175)
Late ART
(n=75)
p-
value
MTCT Rate (%)
1.2
4.8
0.02
Preterm Delivery (%)
10
18
0.04
Low Birth Weight (%)
8
15
0.03
Cesarean Section (%)
30
38
0.15
Maternal Postpartum Complications (%)
5
9
0.08
Table 2 demonstrates that early ART initiation is linked with improved obstetric and neonatal
outcomes.
Literature Synthesis - A systematic review of the literature reinforced the findings of our
institutional study. Multiple studies indicate that multidisciplinary approaches—including early
ART, nutritional counseling, and close fetal monitoring—lead to significant improvements in
outcomes. Meta-analyses consistently show that when ART is initiated during the first trimester
or preconception, MTCT rates can be reduced to below 2%, echoing our local data. Furthermore,
studies have shown that integrated obstetric care with specialized management protocols can
decrease the risks of preterm birth and other adverse outcomes.
DISCUSSION
The current study, along with the supporting literature, underscores the importance of early and
integrated management strategies for HIV-infected pregnant women. Our findings reveal that
early initiation of ART is critical for minimizing MTCT, reducing obstetric complications, and
enhancing neonatal outcomes.
Importance of Early ART Initiation - Early diagnosis and timely initiation of ART are the
cornerstones of effective pregnancy management in HIV-infected women. Women who
commence ART during the first trimester or prior to conception exhibit significantly lower
MTCT rates and reduced rates of preterm labor and low birth weight. This is attributable to
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better viral load suppression, which minimizes placental and systemic inflammatory responses
that could precipitate obstetric complications [3].
Multidisciplinary Approach and Integrated Care - The complexity of managing HIV in
pregnancy necessitates a multidisciplinary approach. In addition to ART, nutritional support,
psychosocial counseling, and regular monitoring are essential. Obstetricians, infectious disease
specialists, neonatologists, and mental health professionals must work collaboratively to provide
comprehensive care [4]. Our cohort data and the literature both indicate that an integrated care
model is associated with better outcomes compared to isolated management strategies.
Obstetric Considerations and Delivery Management - The mode of delivery is an important
factor in reducing MTCT. While elective cesarean section has been recommended in some cases,
our findings indicate that with effective ART and low maternal viral load, vaginal delivery can
be safely undertaken. Nevertheless, obstetric complications such as preterm labor and fetal
distress require vigilant monitoring. Simulation-based training and adherence to established
protocols can enhance team preparedness during emergencies, ultimately improving the safety of
both mother and child [5].
Limitations and Future Directions - This study’s retrospective design and single-center nature
present inherent limitations, including potential selection bias and a lack of generalizability.
Future prospective, multicenter studies are warranted to validate these findings and explore long-
term maternal and child health outcomes. Additionally, there is a need for research into the cost-
effectiveness of integrated management protocols, particularly in resource-limited settings where
the burden of HIV is highest.
Emerging technologies such as point-of-care viral load testing and telemedicine platforms hold
promise for enhancing monitoring and adherence to ART. Future research should focus on
leveraging these tools to optimize care delivery and overcome barriers related to geography and
socioeconomic status [6].
Policy Implications - The results of this study have important policy implications. National and
regional health authorities should prioritize early HIV screening and the establishment of
integrated care pathways for pregnant women. Investments in education, training, and
infrastructure are essential to ensure that all women have access to comprehensive, evidence-
based care regardless of their socioeconomic background [7].
CONCLUSION
In conclusion, the evaluation of pregnancy and delivery management in HIV-infected women
reveals that early ART initiation and a multidisciplinary care approach are paramount to
reducing MTCT and improving both obstetric and neonatal outcomes. Our retrospective analysis,
in conjunction with findings from the literature, demonstrates that when HIV-infected pregnant
women receive timely and integrated care, rates of MTCT can be minimized, and complications
such as preterm birth and low birth weight significantly reduced.
The integration of specialized obstetric protocols, enhanced monitoring techniques, and
coordinated team training is essential in addressing the unique challenges posed by HIV in
pregnancy. Future research should focus on prospective studies, long-term outcomes, and cost-
effective models of care that can be implemented in diverse healthcare settings, particularly in
regions with limited resources. By emphasizing early intervention and collaborative care,
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healthcare systems can not only improve immediate perinatal outcomes but also contribute to the
long-term health and well-being of mothers and their children [8].
Ultimately, the successful management of pregnancy in HIV-infected women requires both
clinical innovation and policy-level support. A sustained commitment to improving care
pathways and overcoming systemic barriers will be crucial in achieving the dual goals of
preventing MTCT and ensuring optimal maternal health.
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1.
World Health Organization. (2021). Global health sector response to HIV, 2019.
Retrieved from [WHO website].
2.
Centers for Disease Control and Prevention. (2020). Guidelines for the prevention of
mother-to-child transmission of HIV. Retrieved from [CDC website].
3.
Townsend, C. L., et al. (2014). Earlier initiation of ART and further decline in mother-to-
child HIV transmission rates, 2000–2011. AIDS, 28(7), 1049-1057.
4.
Brocklehurst, P., et al. (2013). Caesarean section versus vaginal delivery for preventing
mother-to-child transmission of HIV. Cochrane Database of Systematic Reviews, (7).
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Mirpozilovich, Yunusov Muzaffar. "SOCIAL-PSYCHOLOGICAL INTEGRATION
AND REHABILITATION OF INDIVIDUALS WITH AIDS." ИКРО журнал 14, no. 01 (2025):
290-293.
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Юнусов, М.М., 2022. ИЗУЧЕНИЕ ЭФФЕКТИВНОСТИ АНТИРЕТРОВИРУСНОЙ
ТЕРАПИИ В РАННЕМ БЕССИМПТОМНОМ ПЕРИОДЕ ВИЧ-ИНФЕКЦИИ. Экономика и
социум, (11-1 (102)), pp.1278-1281.
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methods for early diagnosis and prognosis of choriocarcinoma. International Journal of
Gynecological Cancer, 32(Suppl 3), pp.A219-A219.
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