Washington, DC is an epicenter of the Human Immunodeficiency Virus (HIV) epidemic in the United States. Pregnancy in women living with HIV is significantly complicated by both the associated medical and psychosocial complications of the disease. Despite the breadth of the HIV crisis in the United States and across the developed world, relatively little is known about these pregnancies in resource rich settings. There is an urgent need to identify the adverse pregnancy outcomes HIV positive women are at risk for in order to better care for these women during pregnancy. Current prenatal care is based on clinical assumptions in the absence of knowledge. Women living with HIV are underserved in pregnancy largely because they are understudied.
Existing literature does not sufficiently evaluate the maternal and neonatal outcomes of pregnancies in the developed world. Several small studies suggest increased maternal and neonatal morbidity in pregnancies complicated by HIV, such as increased rates of preterm birth, cesarean delivery and infection. Large comprehensive studies of obstetric and neonatal outcomes of HIV pregnancies are critically needed to guide the pregnancy care of these women.
We propose a pilot single-site retrospective matched cohort study of maternal and neonatal outcomes from MedStar Washington Hospital Center (MWHC) to then expand to a District-wide study. The proposed pilot study will be the largest comprehensive study of its kind in a resource rich setting and will povide critical insight into maternal and neonatal adverse outcomes in pregnancies complicated by HIV. This pilot will inform the subsequent district-wide prospective study, guiding the design, feasibility, outcomes and sample size. The District-wide study will further inform the care of women living with HIV and pave the way for interventional studies.