# Impact of maternal HIV infection on pregnancy and labor complication and perinatal health outcomes: a South African retrospective study

## TL;DR

This study examines how maternal HIV affects pregnancy outcomes in South Africa, both before and during the COVID-19 pandemic, using hospital records.

## Contribution

The study provides new insights into the impact of maternal HIV on birth outcomes in South Africa during the pandemic.

## Key findings

- Hospital attendance declined during the pandemic, especially among HIV-positive women.
- HIV-positive women had shorter labor and higher cesarean rates during the pandemic.
- Sepsis incidence increased among HIV-positive women during the pandemic.

## Abstract

Maternal HIV infection is associated with increased risks of pregnancy complications and adverse perinatal outcomes, particularly in high-prevalence settings like South Africa. The COVID-19 pandemic disrupted healthcare access, potentially exacerbating challenges in antenatal care and HIV management. To our knowledge, limited South African data exist regarding the impact of maternal HIV on birth complications and perinatal birth outcomes especially during the COVID-19 pandemic.

This study thus evaluates the impact of maternal HIV on pregnancy and perinatal outcomes before and during the COVID-19 pandemic using archived chart records from a tertiary hospital in KwaZulu-Natal, South Africa.

A retrospective analysis of 8456 birth records from March 2019 to December 2020 was conducted, categorized into pre-pandemic and pandemic periods. Data were stratified by maternal HIV status and analyzed for demographics, antenatal care attendance, ART regimens, labor characteristics, and birth outcomes. Statistical tests, including Chi-square and logistic regression, were used to assess associations between HIV status and outcomes.

Hospital attendance declined during the COVID-19 period, especially among women living with HIV, whose age ranged between 19 and 35 years, and were multigravida, and multiparous. Antenatal care attendance was suboptimal and worsened during the COVID-19 period. ART coverage remained high with maintained viral suppression. Women living with HIV had shorter “active labor” and higher elective cesarean rates during the COVID-19 period. Preterm birth risk was also higher pre-pandemic among women living with HIV but not significantly different during COVID-19 period. Birth weights were lower in HIV-exposed infants pre-pandemic with a non-significant shift during COVID-19 period. Sepsis incidence increased among women living with HIV during COVID-19 period. No maternal deaths were reported.

A decline in hospital attendance was noted during the COVID-19 period among women living with HIV, with antenatal care attendance being suboptimal and exacerbated. Maternal HIV remains a critical factor influencing birth outcomes, necessitating sustained focus on tailored care during crises to protect vulnerable populations.