Preterm delivery and low birth weight among neonates born to HIV-positive and HIV-negative Ghanaian women

In sub-Saharan Africa, several hundreds of pregnancies are exposed to both malaria and HIV infections annually. Adverse perinatal outcomes as a result of these infections include preterm delivery (PTD), and low birth weight (LBW). These are not well characterized in Ghana. We determined whether malaria and HIV infections during pregnancy increase the risk of delivering a preterm or a LBW neonate. We enrolled 1,154 women at their first antenatal visit (443 HIV-positive and 711 HIV-negative), and prospectively collected data at delivery on 761 mother-infant pairs. Malaria parasitemia status, HIV status, hemoglobin concentration, and CD4+ cell count were determined using standard methods. We observed a significantly increased risk of LBW among HIV-positive women with malaria at recruitment, odds ratio (OR) = 4.4, 95% Confidence Interval [CI] (2.3 to 8.4), at delivery, OR = 2.5, 95% CI (1.1 to 3.7). The risk among those who were dually-infected at recruitment and at delivery was more pronounced; OR = 11.3; 95% CI (4.6 to 27.4). Dual infection was also associated with a 4-fold risk of delivering preterm; OR = 3.96; 95% CI (1.8 to 8.5). These findings demonstrate that neonates of HIV-positive women with multiple malaria infections are at particular risk of PTD and LBW in Ghana.