Pregnancy outcomes in HIV-infected women

Background: HIV infection during pregnancy remains a significant public health concern in India despite a declining prevalence. Mother-to-child transmission (MTCT) continues to be the primary source of pediatric HIV infection. Early identification of HIV-positive pregnant women and timely initiation of antiretroviral therapy (ART) under the Prevention of Parent-to-Child Transmission (PPTCT) programme are critical for reducing MTCT and improving maternal and neonatal outcomes. Methods: A retrospective observational study was conducted at SVP Hospital and SCL Hospital from January 2015 to December 2024. Fifty HIV-seropositive pregnant women attending antenatal care or presenting in labor and receiving ART were included. HIV testing, counseling, ART initiation, and follow-up were performed in accordance with National AIDS Control Organization (NACO) guidelines. Maternal demographics, obstetric complications, CD4 counts, mode of delivery, and neonatal outcomes, including HIV status at 18 months, were analyzed. Results: Among the 50 women, 28% were newly diagnosed during labor, while 72% were known HIV-positive cases. Most women were aged 25-30 years (44%) and were primigravida (44%). Maternal complications included anemia (40%), fetal growth restriction (26%), pulmonary tuberculosis (14%), and preterm delivery (16%). The live birth rate was 92%. Cesarean section was performed in 84.7% of cases for obstetric indications. CD4 counts were >200 cells/mm³ in 98% of women. Nevirapine prophylaxis was administered to all live-born infants. Of the 46 infants tested at 18 months, only one (1%) was HIV-positive. Low birth weight was observed in 32.6% of neonates, and neonatal mortality was 2.2%. Conclusions: Effective implementation of PPTCT services, including universal antenatal screening, early ART initiation, institutional delivery, neonatal prophylaxis, and follow-up per NACO guidelines, significantly reduces MTCT of HIV. Strengthening early antenatal registration and ART adherence can further improve outcomes.