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Cited by 12HIV/AIDS Research and InterventionsReproductive Health and ContraceptionPregnancy and Medication Impact

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. +6 more·2019·American Journal of Obstetrics and Gynecology
DOI 10.1016/j.ajog.2019.05.034
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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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  • Multiple risk factors of recurrent miscarriage, including metabolic (e.g. obesity) and endocrine (e.g. hypothyroidism) disorders, have been shown to impact adversely on the decidual process in the endometrium.

    “Multiple risk factors of recurrent miscarriage, including metabolic (e.g. obesity) and endocrine (e.g. hypothyroidism) disorders (Table 6), have been shown to impact adversely on the decidual process in the endometrium. 57,58”

    From Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss (2021) · cites this paper as [57]

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Authors
Wall, K. M., Haddad, L. B., Mehta, C. C., Golub, E. T., Rahangdale, L., Dionne-Odom, J., Karim, R., Wright, R. L., Minkoff, H., Cohen, M., Kassaye, S. G., Cohan, D., Ofotokun, I., & Cohn, S. E.
Affiliations
  • Emory University (US)
  • Johns Hopkins University (US)
  • University of North Carolina at Chapel Hill (US)
  • University of Southern California (US)
  • Albert Einstein College of Medicine (US)
  • Maimonides Medical Center (US)
  • John H. Stroger, Jr. Hospital of Cook County (US)
  • Georgetown University (US)
  • University of California, San Francisco (US)
  • Grady Memorial Hospital (US)
  • Northwestern University (US)
Corresponding author
Wall, Kristin M.
ORCID
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
2019-10
Volume
221
Issue
4
Pages
347.e1-347.e13
ISSN
0002-9378 (ISSN-L)
DOI
10.1016/j.ajog.2019.05.034
OpenAlex
W2944894903
Cited by
12
References
55
Citations by year
2026: 1 · 2025: 1 · 2024: 3 · 2023: 3 · 2021: 1 · 2020: 3
FWCI
0.77
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • American Journal of Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institutes of Health
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
Keywords
miscarriage, women living with HIV, pregnancy outcomes, tobacco use, alcohol consumption, cannabis use, HIV viral load, protease inhibitors, highly active antiretroviral therapy, modifiable risk factors, Women's Interagency HIV Study
MeSH terms
Abortion, Spontaneous, Tobacco Smoking, Marijuana Use, Adult, Alcohol Drinking, Female, Humans, Longitudinal Studies, Pregnancy, Protease Inhibitors, Risk Factors, United States, HIV Infections, Logistic Models, Odds Ratio, Viral Load, Antiretroviral Therapy, Highly Active, Young Adult, Protective Factors

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