HIV Infection in Pregnancy and Adverse Perinatal Outcomes: A 14-Year Population-Based Study from a Central European Country Examining Preterm Birth, Low Birth Weight, and Small-for-Gestational-Age Newborns

Despite major advances in antiretroviral therapy (ART), maternal HIV infection remains an important public health concern with potential consequences for perinatal outcomes. Although vertical transmission has markedly declined, uncertainty persists regarding the association between maternal HIV status and low birth weight (LBW), small-for-gestational-age (SGA) newborns, and preterm birth (PTB). We conducted a population-based retrospective analysis using two national health registries in the Czech Republic, encompassing 1,458,648 births between 2010 and 2023. The study included 164 singleton live births to HIV-positive mothers and a random control sample of 20,000 HIV-negative mothers selected from 1.43 million eligible births. Binomial and multinomial logistic regression models were used to assess associations between maternal HIV status and adverse perinatal outcomes. Results are presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs) and p values. Maternal HIV infection was associated with significantly increased odds of LBW (aOR 1.766, 95% CI 1.050–2.967; p = 0.032) and SGA (aOR 2.206, 95% CI 1.472–3.304; p < 0.001). The association with PTB was not statistically significant (aOR 1.251, 95% CI 0.693–2.259; p = 0.457). Infants born to HIV-positive mothers had lower mean birthweight and lower gestational age at delivery compared with HIV-negative controls. Caesarean delivery was more frequent among HIV-positive women (40.2 vs. 23.7%). In this 14-year national cohort, maternal HIV infection was associated with impaired fetal growth—reflected by higher risks of LBW and SGA—but not with preterm birth. These findings underscore the need for enhanced fetal monitoring in pregnancies affected by HIV and support further investigation into the roles of ART regimens, maternal immune status, and regional epidemiological factors.