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Measurement error in gestational age may bias the relationship between combination ART and gestational age-based outcomes. We demonstrate the use of multiple overimputation to address missing data and measurement error in gestational age. Using routinely collected clinical data from public health facilities in Lusaka, Zambia, we multiply imputed missing data and multiply overimputed observed values of gestational age.
Poisson models with robust variance estimators were used to estimate risk ratios RRs for the associations of duration of combination ART with small for gestational age SGA and preterm birth. We compared results from a complete-case analysis, using multiple imputation to address missing data only, and using multiple overimputation to address missing data and measurement error.
In the complete-case analysis, there was no evidence of an association between duration of combination ART and SGA or preterm birth. For preterm birth, RRs for weeks of combination ART moved away from the null as the variance due to measurement error increased. When we used multiple overimputation to account for measurement error and missing data, we observed an increased risk of preterm birth with longer duration of combination ART. Future analyses examining associations between combination ART and pregnancy outcomes should consider using multiple overimputation to address measurement error in gestational age.
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Of 50, HIV-infected women with antenatal visits between January and September , 4, women met the inclusion criteria. These findings were consistent across several sensitivity analyses. Longer duration of cART was not associated with poor fetal growth among term pregnancies in our cohort. However, the relationship between cART and adverse pregnancy outcomes remains complicated. Continued work is required to investigate causality.
However, cART use during pregnancy could negatively affect fetal growth. Duration of cART during pregnancy is directly related length of gestation, making it difficult to meaningfully assess the association between duration of treatment and PTB. We, therefore, limited our analysis cohort to those infants delivered at term. We conducted a retrospective cohort analysis of HIV-infected pregnant women attending public antenatal healthcare facilities in Lusaka, Zambia.
Duration of cART is directly related to length of gestation; with each week that a woman remains pregnant and on cART, the probability of having a preterm birth diminishes. This could result in a spurious association between duration of treatment and preterm birth, where women on cART longer appear less likely to have a preterm birth. For this reason, we limited our analysis cohort to those infants delivered at term and focused on an outcome of LBW. In resource-limited settings such as Zambia, where ultrasound is not routinely available, LBW among infants delivered at term can be considered a proxy for IUGR.
To minimize confounding, this group was also excluded.
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Keywords: antiretroviral therapy, fetal growth restriction, HIV, low birthweight, pregnancy of HIV-infected women eligible to initiate cART for maternal health in Zambia. Gestational age dating based on LMP is known to contain error.(32, 33).
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Canada: Activists deplore media article perpetuating misinformaton and ignoring scientific breakthroughs Fuelling myths about HIV in the age of misinformation. How is the Expert Consensus Statement bringing science to justice? July 6,