Main Article Content

Marco Floridia
Giulia Masuelli
Beatrice Tassis
Enrica Tamburrini
Valeria Savasi
Matilde Sansone
Arsenio Spinillo
Giuseppina Liuzzi
Anna Degli Antoni
Serena Dalzero
Laura Franceschetti
Giuliana Simonazzi
Gianpaolo Maso
Daniela Francisci
Carmela Pinnetti
Marina Ravizza
(*) Corresponding Author:


Background: There is limited information on pregnancy loss in women with HIV, and it is still debate whether HIV-related markers may play a role.

Objectives: To explore potential risk factors for pregnancy loss in women with HIV, with particular reference to modifiable risk factors and markers of HIV disease.

Methods: Multicenter observational study of HIV-positive pregnant women. The main outcome measure was pregnancy loss, including both miscarriage (<22 weeks) and stillbirth (?22 weeks). Possible associations of pregnancy loss were evaluated in univariate and multivariate analyses.

Results: Among 2696 eligible pregnancies reported between 2001 and 2018, 226 (8.4%) ended in pregnancy loss (miscarriage 198, 7.3%; stillbirth 28, 1.0%). In multivariate analyses, only older age (adjusted odds ratio [AOR] per additional year of age: 1.079, 95% confidence interval [CI], HIV diagnosis before pregnancy (AOR: 2.533, 95%CI 1.407-4.561) and history of pregnancy loss (AOR: 1.625, 95%CI 1.178-2.243) were significantly associated with pregnancy loss. No significant association with pregnancy loss was found for parity, coinfections, sexually transmitted diseases, hypertension, smoking, alcohol and substance use, CD4 cell count, HIV-RNA viral load and CDC HIV stage.

Conclusions: Older women and those with a previous history of pregnancy loss should be considered at higher risk of pregnancy loss. The severity of HIV disease and potentially modifiable risk factors apparently did not increase the risk of pregnancy loss.

Downloads month by month


Download data is not yet available.

Article Details


Laursen T, Kesmodel US, Højgaard A, Østergaard L, Ingerslev HJ,
Wejse C. Reproductive patterns and fertility wishes among HIV-infected
patients: survey from six outpatient clinics in Denmark. Int J Infect Dis
2013; 17: e851-6.
2. Nöstlinger C, Desjardins F, Dec J, Platteau T, Hasker E; Eurosupport V
Study Group. Child desire in women and men living with HIV attending
HIV outpatient clinics: evidence from a European multicentre study. Eur
J Contracept Reprod Health Care 2013; 18: 251-63.
3. Berhan Y, Berhan A. Meta-analyses of fertility desires of people living
with HIV. BMC Public Health 2013; 13: 409.
PMid:23627965 PMCid:PMC3649930
4. Wessman M, Aho I, Thorsteinsson K, et al. Perception of sexuality and
fertility in women living with HIV: a questionnaire study from two
Nordic countries. J Int AIDS Soc 2015; 18: 19962.
PMid:26037151 PMCid:PMC4452736
5. Hernando V, Alejos B, Montero M, et al. Reproductive history before
and after HIV diagnosis: A cross-sectional study in HIV-positive women
in Spain. Medicine 2017; 96: e5991.
PMid:28151893 PMCid:PMC5293456
6. Ramos de Souza M, do Amaral WN, Alves Guimarães R, Rezza G,
Brunini SM. Reproductive desire among women living with HIV/AIDS
in Central Brazil: Prevalence and associated factors. PLoS One 2017;
12: e0186267.
PMid:29053712 PMCid:PMC5650151
7. Lo CK, Kennedy VL, Yudin MH, Shapiro HM, Loutfy M. Access to
fertility services in Canada for HIV-positive individuals and couples: a
comparison between 2007 and 2014. AIDS Care 2017; 29: 1433-1436.
8. Cohn SE, Haddad LB, Sheth AN, et al. Parenting Desires Among
Individuals Living With Human Immunodeficiency Virus in the United
States. Open Forum Infect Dis 2018; 5: ofy232.
9. Hirst JE, Villar J, Victora CG, et al. The antepartum stillbirth syndrome:
risk factors and pregnancy conditions identified from the
INTERGROWTH-21st Project. BJOG 2018; 125: 1145-1153.
PMid:28029221 PMCid:PMC6055673
10. Flenady V, Koopmans L, Middleton P, et al. Major risk factors for
stillbirth in high-income countries: a systematic review and metaanalysis.
Lancet 2011; 377: 1331-40.
11. Gutaj P, Zawiejska A, Wender-O?egowska E, Br?zert J. Maternal
factors predictive of first trimester pregnancy loss in women with
pregestational diabetes. Pol Arch Med Wewn 2013; 123: 21-8.
12. Poorolajal J, Cheraghi P, Cheraghi Z, Ghahramani M, Doosti Irani A.
Predictors of miscarriage: a matched case-control study. Epidemiol
Health 2014; 36: e2014031.
PMid:25420952 PMCid:PMC4282085
13. Warr AJ, Pintye J, Kinuthia J, et al. Sexually transmitted infections
during pregnancy and subsequent risk of stillbirth and infant mortality in
Kenya: a prospective study. Sex Transm Infect 2018. [Epub ahead of
PMid:30228109 PMCid:PMC6525108
14. Kim HY, Kasonde P, Mwiya M, et al. Pregnancy loss and role of infant
HIV status on perinatal mortality among HIV-infected women. BMC
Pediatr 2012; 12: 138.
PMid:22937874 PMCid:PMC3480840
15. Cates JE, Westreich D, Edmonds A, et al. The Effects of Viral Load
Burden on Pregnancy Loss among HIV-Infected Women in the United
States. Infect Dis Obstet Gynecol 2015; 2015: 362357.
PMid:26582966 PMCid:PMC4637076
16. Westreich D, Cates J, Cohen M, et al. Smoking, HIV, and risk of
pregnancy loss. AIDS 2017; 31: 553-560.
PMid:27902507 PMCid:PMC5263172
17. Stringer EM, Kendall MA, Lockman S, et al. Pregnancy outcomes
among HIV-infected women who conceived on antiretroviral therapy.
PLoS One 2018; 13: e0199555.
PMid:30020964 PMCid:PMC6051581
18. Hoffman RM, Brummel SS, Britto P, et al. Adverse Pregnancy
Outcomes among Women who Conceive on Antiretroviral Therapy.
Clin Infect Dis 2018. [Epub ahead of print]
PMid:29868833 PMCid:PMC6321847
19. Floridia M, Mastroiacovo P, Tamburrini E, et al.Birth defects in a
national cohort of pregnant women with HIV infection in Italy, 2001-
2011. BJOG 2013; 120:1466-75.
20. Kotz D, Fidler J, West R. Very low rate and light smokers: smoking
patterns and cessation-related behaviour in England, 2006-11. Addiction
2012; 107: 995-1002.
21. Ministero della Salute - Sistema Nazionale per le linee guida. Linee
guida per la gravidanza fisologica. Aggiornamento 2011. Available at: Accessed on january
10, 2019.
22. ISTAT - Istituto Nazionale di statistica. La salute riproduttiva della
donna. Available at Accessed
January 10, 2019.
23. Mandelbrot L, Tubiana R, Le Chenadec J, et al. No perinatal HIV-1
transmission from women with effective antiretroviral therapy starting
before conception. Clin Infect Dis 2015; 61: 1715-25.
24. Uthman OA, Nachega JB, Anderson J, et al. Timing of initiation of
antiretroviral therapy and adverse pregnancy outcomes: a systematic
review and meta-analysis. Lancet HIV 2017; 4: e21-e30.

Most read articles by the same author(s)