RE: [pronut-hiv] Anemia, Hypertension Risks Increased in Pregnant HIV-Infected Women (4)

["Oluoch, Patricia" <poluoch@ke.cdc.gov>]

I concur totally

Patricia 


-----Christine Sadia wrote:
Dear Patricia,
   
  Thanks for bringing back people to basics of health care issues such
as SafeMother hood initiatives and pratices that have existed for a long
time and worked for pregnant women and which could be done at community
level and peripheral health facilities. I would like to concur with you
and ask the reseachers to situate this outcome on what kind of study
protocol, design and methodology. What was the study design and period?
Was it a randomised clinical trial? Was there a control group and was
the design appropriate to give this ourcome conclusively. A few issues
come to the fore:
  1. Inclusion and exclusion criteria
  2. Service availability to all study subjects
  3. Removal of biases as we know a positive pregnat women may be
undergoing other factors which needed to be control and hence the need
for a control group.
   
  I may be unfair to the reseacher, but the background is important to
be able to say whether this finding can be generalised. It is also a
known fact that a positive pregnant woman is likely to be anaemic, lower
weight, suffer opportunistic infections and stressed that a positive
pregnant woman. In my view, these findings though not reported are quite
consistent with what one expect in a clinical practise and kindly give
us what is unique and recommendations on interventions that would
improve management and caring for positive pregnant women. In Southern
Africa, issues of food insecurity, violence against women etc. may be
some of the comfounding factors.
   
  Thanks for the work and I hope to hear more.
   
  Christine -Working with positive women in HBC settings.
   
   
  

-----"Oluoch, Patricia" <poluoch@ke.cdc.gov> wrote:
  

It is very interesting to note that the results are attributed to lack
of guidelines for midwives. It would be interesting to know the nature
of guidelines expected. Any pregnant woman whether HIV positive or not
is evaluated for anaemia and hypertension at each visit to the ante
natal clinic as part of the comprehensive care package. In Safe
motherhood the emphasis is put on focused antenatal care more than
anything else and there are standard examinations carried out including
for anaemia and high blood pressure plus screening for STIs among
others. Many centres administer iron tablets and folic acid and possibly
multivitamins as a matter of course to pregnant women as part of the
comprehensive care package.
Perhaps the researchers can shed more light on the guidelines they are
recommending.

Midwife
Kenya

Patricia Oluoch

-----ProNut-HIV wrote:

Anemia, Hypertension Risks Increased in Pregnant HIV-Infected Women

NEW YORK (Reuters Health) Jun 28 - HIV-positive women are much more
likely to have anemia and hypertension during pregnancy, and to deliver
infants with lower birth weight and retarded growth, than HIV-negative
women, according to a study conducted in South Africa.

In the latest issue of the Journal of Clinical Nursing, the study team
says, to their knowledge, the "unique" finding of an increase in
prevalence of anemia and pregnancy-induced hypertension in HIV-positive
pregnant women has not been reported elsewhere in the literature.

Dr. Candice Bodkin and two colleagues from the University of
Witwatersrand in South Africa reviewed the maternal and neonatal
outcomes of 212 HIV-positive and 101 matched HIV-negative women.

Compared with the HIV-negative women, the HIV-positive group had
significantly lower hemoglobin levels (10.85 vs 11.48 g/dL), weighed
significantly less (72.07 vs 76.69 kg) and were significantly more
likely to present with abnormal vaginal discharge (33% vs 25%).

They also made significantly fewer antenatal clinic visits; 17% received
no antenatal care.

The difference in the prevalence of pregnancy-induced hypertension
between HIV-positive and HIV-negative women (17% vs 10%) "approached
significance," according to the team, as did the difference in the
prevalence of syphilis infection (6% vs 1%), and urinary tract infection
(16% vs 8%).

Neonatal outcomes also differed between the two groups. HIV-positive
women were significantly more likely than HIV-negative women to have
intrauterine growth retardation (5% vs 0%), to deliver earlier (38 weeks
vs 38.5 weeks) and to deliver an infant of low birth weight (2970 vs
3138 grams).

More than one quarter of pregnant women in South Africa are
HIV-positive, Dr. Bodkin and colleagues point out. They say the high
rate of HIV- and AIDS-related maternal morbidity and mortality in South
Africa has been attributed to the lack of guidelines for midwives'
antenatal assessment and management of HIV-positive pregnant women.

"This study," write the researchers, "identifies maternal and neonatal
outcomes related to HIV infection in pregnancy and provides evidence
required to inform the development of clinical practice guidelines."

J Clin Nursing 2006;15:735-741.