Download PDF
Am J Perinatol 2021; 38(08): 753-758
DOI: 10.1055/s-0040-1721714
SMFM Fellowship Series Article

Social Vulnerability among Foreign-Born Pregnant Women and Maternal Virologic Control of HIV

Ashish Premkumar
1   Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
2   Department of Anthropology, The Graduate School, Northwestern University, Evanston, Illinois
,
Lynn M. Yee
1   Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
,
Lia Benes
1   Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
,
Emily S. Miller
1   Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
› Author Affiliations Funding L.M.Y. was funded by 2K12 HD050121 at the time of the study.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective The aim of this study was to assess whether social vulnerability among foreign-born pregnant women living with HIV is associated with maternal viremia during pregnancy.

Study Design This retrospective cohort study included all foreign-born pregnant women living with HIV who received prenatal care in a multidisciplinary prenatal clinic between 2009 and 2018. A licensed clinical social worker evaluated all women and kept detailed clinical records on immigration status and social support. Social vulnerability was defined as both living in the United States for less than 5 years and reporting no family or friends for support. The primary outcome was evidence of viral non-suppression after achievement of initial suppression. Secondary outcomes were the proportion of women who required > 12 weeks after starting antiretroviral therapy to achieve viral suppression, median time to first viral suppression (in weeks) after initiation of antiretroviral therapy, and the proportion who missed ≥ 5 doses of antiretroviral therapy. Bivariable analyses were performed.

Results A total of 111 foreign-born women were eligible for analysis, of whom 25 (23%) were classified as socially vulnerable. Social and clinical characteristics of women diverged by social vulnerability categorization but no differences reached statistical significance. On bivariable analysis, socially-vulnerable women were at increased risk for needing > 12 weeks to achieve viral suppression (relative risk: 1.78, 95% confidence interval: 1.18–2.67), though there was no association with missing ≥ 5 doses of antiretroviral therapy or median time to viral suppression after initiation of antiretroviral therapy.

Conclusion Among foreign-born, pregnant women living with HIV, markers of virologic control during pregnancy were noted to be worse among socially-vulnerable women. Insofar as maternal viremia is the predominant driver of perinatal transmission, closer clinical surveillance and support may be indicated in this population.

Key Points

  • 23% of foreign-born pregnant women living with HIV were identified as socially vulnerable.

  • Socially-vulnerable women were at higher risk for re-emergent viremia (24 vs. 7%, RR 3.44).

  • Socially-vulnerable women were at higher risk for needing >12 weeks to become aviremic (64 vs. 36%, RR: 1.7).

Keywords

social vulnerability - social determinants of health - HIV - mother-to-child transmission

Note

This study was presented as an abstract at the Society for Maternal-Fetal Medicine's 40th Annual Pregnancy Meeting, February 3–8, 2020, Grapevine, TX.




Publication History

Received: 24 June 2020

Accepted: 04 November 2020

Article published online:
25 December 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 HIV and Women. Centers for Disease Control, 2019. https://www.cdc.gov/hiv/pdf/group/gender/women/cdc-hiv-women.pdf . Accessed November 24, 2020
    Google Scholar
  • 2 Selected National HIV Prevention and Care Outcomes. Centers for Disease Control, 2015. https://www.cdc.gov/hiv/pdf/library/slidesets/cdc-hiv-prevention-and-care-outcomes.pdf . Accessed November 24, 2020
    Google Scholar
  • 3 World Health Organization (WHO). Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. Geneva, Switzerland: World Health Organization; 2013
    Google Scholar
  • 4 Immigration. The Center for HIV Law & Policy, 2019. https://www.hivlawandpolicy.org/issues/immigration . Accessed November 24, 2020
    Google Scholar
  • 5 Sargent C, Larchanché S. Transnational migration and global health: the production and management of risk, Illness, and access to care. Annu Rev Anthropol 2011; 40: 345-361
    CrossrefPubMedGoogle Scholar
  • 6 Fox M, Thayer Z, Wadhwa PD. Acculturation and health: the moderating role of socio-cultural context. Am Anthropol 2017; 119 (03) 405-421
    CrossrefPubMedGoogle Scholar
  • 7 Lopez-Class M, Castro FG, Ramirez AG. Conceptions of acculturation: a review and statement of critical issues. Soc Sci Med 2011; 72 (09) 1555-1562
    CrossrefPubMedGoogle Scholar
  • 8 Schwartz SJ, Unger JB, Zamboanga BL, Szapocznik J. Rethinking the concept of acculturation: implications for theory and research. Am Psychol 2010; 65 (04) 237-251
    CrossrefPubMedGoogle Scholar
  • 9 Farmer P, Kleinman A. AIDS as human suffering. Daedalus 1989; 118: 135-160
    PubMedGoogle Scholar
  • 10 Treichler P. The Burdens of History: Gender and Representation in AIDS Discourse, 1981–1988. How to Have Theory in An Epidemic: Cultural Chronicles of AIDS. Durham, NC: Duke University Press; 1999: 42-98
    Google Scholar
  • 11 Watkins-Hayes C. Remaking a Life: How Women Living with HIV/AIDS Confront Inequality. Oakland, CA: University of California Press; 2019
    Google Scholar
  • 12 Watkins-Hayes C. Intesectionality and the sociology of HIV/AIDS: past, present, and future research directions. Annu Rev Sociol 2014; 40: 431-457
    CrossrefPubMedGoogle Scholar
  • 13 Townsend P. Poverty in the United Kingdom: A Survey of Household Resources and Standards of Living. New York, NY: Penguin; 1979
    CrossrefGoogle Scholar
  • 14 Kapaya H, Mercer E, Boffey F, Jones G, Mitchell C, Anumba D. Deprivation and poor psychosocial support are key determinants of late antenatal presentation and poor fetal outcomes–a combined retrospective and prospective study. BMC Pregnancy Childbirth 2015; 15: 309
    CrossrefPubMedGoogle Scholar
  • 15 Gonthier C, Estellat C, Deneux-Tharaux C. et al. Association between maternal social deprivation and prenatal care utilization: the PreCARE cohort study. BMC Pregnancy Childbirth 2017; 17 (01) 126
    CrossrefPubMedGoogle Scholar
  • 16 Jordan H, Roderick P, Martin D. The Index of Multiple Deprivation 2000 and accessibility effects on health. J Epidemiol Community Health 2004; 58 (03) 250-257
    CrossrefPubMedGoogle Scholar
  • 17 Figueroa JF, Frakt AB, Jha AK. Addressing social determinants of health: time for a polysocial risk score. JAMA 2020; 323 (16) 1553-1554 [ePub ahead of print]
    CrossrefPubMedGoogle Scholar
  • 18 Enhanced Case Management. 2020 http://www.pregnantandpositive.org/programs/enhanced-case-management/ . Accessed November 24, 2020
    Google Scholar
  • 19 Bourgois P, Holmes SM, Sue K, Quesada J. Structural vulnerability: operationalizing the concept to address health disparities in clinical care. Acad Med 2017; 92 (03) 299-307
    CrossrefPubMedGoogle Scholar
  • 20 Urquia ML, Frank JW, Moineddin R, Glazier RH. Immigrants' duration of residence and adverse birth outcomes: a population-based study. BJOG 2010; 117 (05) 591-601
    CrossrefPubMedGoogle Scholar
  • 21 Garcia PM, Kalish LA, Pitt J. et al; Women and Infants Transmission Study Group. Maternal levels of plasma human immunodeficiency virus type 1 RNA and the risk of perinatal transmission. N Engl J Med 1999; 341 (06) 394-402
    CrossrefPubMedGoogle Scholar
  • 22 Vandenbroucke JP, von Elm E, Altman DG. et al; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med 2007; 4 (10) e297
    CrossrefPubMedGoogle Scholar
  • 23 Barcelona de Mendoza V, Harville E, Theall K, Buekens P, Chasan-Taber L. Acculturation and adverse birth outcomes in a predominantly Puerto Rican population. Matern Child Health J 2016; 20 (06) 1151-1160
    CrossrefPubMedGoogle Scholar
  • 24 Cobas JA, Balcazar H, Benin MB, Keith VM, Chong Y. Acculturation and low-birthweight infants among Latino women: a reanalysis of HHANES data with structural equation models. Am J Public Health 1996; 86 (03) 394-396
    CrossrefPubMedGoogle Scholar
  • 25 Coonrod DV, Bay RC, Balcazar H. Ethnicity, acculturation and obstetric outcomes. Different risk factor profiles in low- and high-acculturation Hispanics and in white non-Hispanics. J Reprod Med 2004; 49 (01) 17-22
    PubMedGoogle Scholar
  • 26 Crump C, Lipsky S, Mueller BA. Adverse birth outcomes among Mexican-Americans: are US-born women at greater risk than Mexico-born women?. Ethn Health 1999; 4 (1-2): 29-34
    CrossrefPubMedGoogle Scholar
  • 27 D'Anna-Hernandez KL, Hoffman MC, Zerbe GO, Coussons-Read M, Ross RG, Laudenslager ML. Acculturation, maternal cortisol, and birth outcomes in women of Mexican descent. Psychosom Med 2012; 74 (03) 296-304
    CrossrefPubMedGoogle Scholar
  • 28 English PB, Kharrazi M, Guendelman S. Pregnancy outcomes and risk factors in Mexican Americans: the effect of language use and mother's birthplace. Ethn Dis 1997; 7 (03) 229-240
    PubMedGoogle Scholar
  • 29 Ruiz RJ, Pickler RH, Marti CN, Jallo N. Family cohesion, acculturation, maternal cortisol, and preterm birth in Mexican-American women. Int J Womens Health 2013; 5: 243-252
    Google Scholar
  • 30 Ruiz RJ, Saade GR, Brown CE. et al. The effect of acculturation on progesterone/estriol ratios and preterm birth in Hispanics. Obstet Gynecol 2008; 111 (2 Pt 1): 309-316
    CrossrefPubMedGoogle Scholar
  • 31 Katz IT, Shapiro R, Li D. et al. Risk factors for detectable HIV-1 RNA at delivery among women receiving highly active antiretroviral therapy in the women and infants transmission study. J Acquir Immune Defic Syndr 2010; 54 (01) 27-34
    CrossrefPubMedGoogle Scholar
  • 32 Boucoiran I, Albert AYK, Tulloch K. et al. Human immunodeficiency virus viral load rebound near delivery in previously suppressed, combination antiretroviral therapy-treated pregnant women. Obstet Gynecol 2017; 130 (03) 497-501
    CrossrefPubMedGoogle Scholar
  • 33 Patel M, Tedaldi E, Armon C. et al; HOPS Investigators. HIV RNA suppression during and after pregnancy among women in the HIV outpatient study, 1996 to 2015. J Int Assoc Provid AIDS Care 2018; 17: 2325957417752259
    CrossrefPubMedGoogle Scholar
  • 34 Sha BE, Tierney C, Cohn SE. et al; Aids Clinical Trials Group ACTG A5150 Team. Postpartum viral load rebound in HIV-1-infected women treated with highly active antiretroviral therapy: AIDS Clinical Trials Group Protocol A5150. HIV Clin Trials 2011; 12 (01) 9-23
    CrossrefPubMedGoogle Scholar
  • 35 Fassin D, D'Halluin E. The truth from the body: medical certificates as ultimate evidence for asylum seekers. Am Anthropol 2005; 107: 597-608
    CrossrefPubMedGoogle Scholar
  • 36 Ticktin M. Where ethics and politics meet: the violence of humanitarianism in France. Am Ethnol 2005; 33: 33-49
    CrossrefPubMedGoogle Scholar