Trends in preterm birth in women living with HIV in Switzerland over the last three decades: A multicentric, prospective, cohort study.

BACKGROUND: HIV infection and its management during pregnancy to reduce perinatal transmission has been associated with preterm birth (PTB). This management has drastically changed. We aimed to evaluate changes in rates of PTB over 34 years in women living with HIV (WLWH) in Switzerland, and to identify factors and interventions associated with these changes. METHODS: We analysed data from 1238 singleton pregnancies, prospectively collected by the Swiss Mother and Child HIV Cohort Study (MoCHiV) and the Swiss HIV Cohort Study (SHCS) between 1986 and 2020. Rates of PTB in this cohort were compared with that of the general Swiss population for three time periods according to changing treatment strategies recommended at the time. We evaluated the association of PTB with sociodemographic, HIV infection and obstetric variables in uni- and multivariate logistic regression. RESULTS: Rate of PTB in WLWH was highest prior to 2010 (mean 20.4%), and progressively decreased since then (mean 11.3%), but always remained higher than in the general population (5%). Older maternal age, lower CD4 count and detectable viraemia at third trimester (T3), drug consumption and mode of delivery were all significantly associated with both PTB and period of study in univariate analysis. There was no association between PTB and type of antiretroviral regimen. No difference was found in the rate of spontaneous labor between PTB and term delivery groups. Only higher CD4 count at T3 and vaginal delivery were significantly associated with a decrease in PTB over time in multivariate analysis. CONCLUSIONS: Preterm birth in WLWH in Switzerland has drastically decreased over the last three decades, but remains twice the rate of that in the general population. Improved viral control and changes in mode of delivery (vaginal birth recommended if viral loads are low near birth) have led to this progress.

Avoiding late preterm deliveries to reduce neonatal complications: an 11-year cohort study.

BACKGROUND: Late preterm (LPT) newborns, defined as those born between 34 0/7 and 36 6/7 gestational weeks, have higher short- and long-term morbidity and mortality than term infants (≥37 weeks). A categorization to justify a non-spontaneous LPT delivery has been proposed to distinguish evidence-based from non-evidence-based criteria. This study aims to describe rates and temporal trends of non-spontaneous LPT neonates delivered according to evidence-based or non-evidence-based criteria and to evaluate the number of avoidable LPT deliveries, including severe neonatal morbidity rates and associated risk factors. METHODS: Retrospective cohort study including all LPT neonates born at a Swiss university maternity unit between January 1, 2002 and December 31, 2012. Trends of LPT neonates and neonatal complications were assessed across time using Poisson regression and risk factors for neonatal complications by logistic regression. RESULTS: Among 40,609 singleton live births, 4223 (10.5%) were preterm and 2017 (4.9%) LPT. In the latter group, 26.2% were non-spontaneous (evidence-based: 12.0%; non-evidence-based: 14.2%). The most frequent indications for evidence-based non-spontaneous LPT delivery were severe preeclampsia (51.8%) and abnormal fetal tracing (24.7%). Indications for non-evidence-based non-spontaneous LPT deliveries were hemorrhage (36.2%) and mild preeclampsia (15.7%). LPT birth rates remained stable over time. The rate of neonatal complications after non-evidence-based LPT birth remained high over time (43.8% vs. 43.5% in 2002 and 2012, respectively; P = 0.645), whereas the annual proportion of neonatal complications overall showed a decreasing trend (from 38.0% in 2002 to 33.5% in 2012; P = 0.051). CONCLUSIONS: LPT birth rates were stable over time, but neonatal complications remained high, particularly after non-evidence-indicated LPT birth. A total of 287 LPT births could have been potentially avoided if an evidence-based protocol for delivery indications had been used. Efforts should be made to avoid non-spontaneous LPT births in order to reduce neonatal complications.

[Preventing whooping cough in infants : vaccinated mother, protected newborn]. / Prévenir la coqueluche chezle nouveau-né : mère vaccinée durant la grossesse, nourrisson protégé.

Pertussis is a serious health issue in infants < 3 months. Too young to be vaccinated, they are at higher risk of developing pertussis and vulnerable to severe complications. Two vaccine strategies exist to prevent infant pertussis. The older « cocooning ¼ strategy involves vaccinating parents and close contacts, indirectly protecting newborns. The more effective strategy is to immunize women during pregnancy, providing infants passive protection by transplacental transfer of pertussis antibodies. However, some women and their caregivers are worried about receiving the vaccine during pregnancy. We review the effectiveness, safety, timing and implementation of pertussis antenatal immunization. The aim is to remind practitioners of current recommendations with supporting data. This can be used to reassure future parents and enable informed decisions.

La coqueluche est un problème de santé important chez les nourrissons de < 3 mois. Trop jeunes pour débuter leur vaccination, ils sont vulnérables à la maladie et font des complications sévères. Deux stratégies existent pour prévenir la coqueluche néonatale. Le «cocooning¼ consiste à vacciner les parents/proches dans le postpartum. La stratégie plus efficace est celle de vacciner les femmes pendant la grossesse, donnant une immunité passive au nouveau-né par le transfert transplacentaire des anticorps maternels. Cependant, certaines femmes enceintes et leurs soignants sont réticents à la vaccination. Nous présentons une revue de l'efficacité, la sécurité, du timing et l'implantation de l'immunisation anténatale contre la coqueluche. Le but est de rappeler ces recommandations et leur justification, pour pouvoir rassurer les futurs parents et leur permettre un choix éclairé.

Antenatal vaccination to decrease pertussis in infants: safety, effectiveness, timing, and implementation.

Pertussis remains a serious global health issue in infants aged less than 6 months. Neonates and young infants have the highest risk of developing pertussis as they are too young to be vaccinated and thus are more likely to develop more severe pertussis-related complications, including death. Protecting this vulnerable age population from pertussis is considered a main priority in many national health programs. Two vaccine strategies exist to protect infants from pertussis: "cocooning" and maternal vaccination during pregnancy. The latter is the more recent and preferred strategy, which protects newborns by passive transplacental transfer of pertussis antibodies. We review the reported evidence on the safety, effectiveness, timing and implementation of this antenatal immunization strategy.