Adverse Perinatal Outcomes among Adolescent Pregnant Women Living with HIV: A Propensity-Score-Matched Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Propensity-Score Matching
2.2. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Ganchimeg, T.; Ota, E.; Morisaki, N.; Laopaiboon, M.; Lumbiganon, P.; Zhang, J.; Yamdamsuren, B.; Temmerman, M.; Say, L.; Tunçalp, Ö.; et al. Pregnancy and childbirth outcomes among adolescent mothers: A World Health Organization multicountry study. BJOG 2014, 121, 40–48. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- UNFPA Girlhood, Not Motherhood: Preventing Adolescent Pregnancy; United Nations Population Fund: New York, NY, USA, 2015; Available online: https://www.unfpa.org/sites/default/files/pub-pdf/Girlhood_not_motherhood_final_web.pdf (accessed on 15 January 2023).
- Zangiacomi Martinez, E.; da Roza, D.L. Ecological analysis of adolescent birth rates in Brazil: Association with Human Development Index. Women Birth 2020, 33, e191–e198. [Google Scholar] [CrossRef] [PubMed]
- Joint United Nations Programme on HIV/AIDS (UNAIDS). Young People and HIV 2021. Available online: https://www.unaids.org/sites/default/files/media_asset/young-people-and-hiv_en.pdf (accessed on 10 January 2023).
- Szwarcwald, C.L.; Júnior, P.R.B.; Pascom, A.R.P.; Coelho, R.A.; Ribeiro, R.A.; Damacena, G.N.; Malta, D.C.; Pimenta, M.C.; Pereira, G.F.M. HIV incidence estimates by sex and age group in the population aged 15 years or over, Brazil, 1986–2018. Rev. Soc. Bras. Med. Trop. 2022, 55 (Suppl. 1), e0231. [Google Scholar] [CrossRef] [PubMed]
- Leftwich, H.K.; Alves, M.V.O. Adolescent Pregnancy. Pediatr. Clin. N. Am. 2017, 64, 381–388. [Google Scholar] [CrossRef]
- Lambonmung, A.; Acheampong, C.A.; Langkulsen, U. The Effects of Pregnancy: A Systematic Review of Adolescent Pregnancy in Ghana, Liberia, and Nigeria. Int. J. Environ. Res. Public Health 2023, 20, 605. [Google Scholar] [CrossRef]
- Gortzak-Uzan, L.; Hallak, M.; Press, F.; Katz, M.; Shoham-Vardi, I. Teenage pregnancy: Risk factors for adverse perinatal outcome. J. Matern. Fetal Med. 2001, 10, 393–397. [Google Scholar] [CrossRef]
- Portwood, C.; Sexton, H.; Kumarendran, M.; Brandon, Z.; Kirtley, S.; Hemelaar, J. Adverse perinatal outcomes associated with antiretroviral therapy in women living with HIV: A systematic review and meta-analysis. Front. Med. 2023, 9, 924593. [Google Scholar] [CrossRef]
- Xiao, P.L.; Zhou, Y.B.; Chen, Y.; Yang, M.X.; Song, X.X.; Shi, Y.; Jiang, Q.W. Association between maternal HIV infection and low birth weight and prematurity: A meta-analysis of cohort studies. BMC Pregnancy Childbirth 2015, 15, 246. [Google Scholar] [CrossRef] [Green Version]
- Amoadu, M.; Hagan, D.; Ansah, E.W. Adverse obstetric and neonatal outcomes of adolescent pregnancies in Africa: A scoping review. BMC Pregnancy Childbirth 2022, 22, 598. [Google Scholar] [CrossRef]
- Dinwiddie, K.J.; Schillerstrom, T.L.; Schillerstrom, J.E. Postpartum depression in adolescent mothers. J. Psychosom. Obstet. Gynaecol. 2018, 39, 168–175. [Google Scholar] [CrossRef]
- Portwood, C.; Sexton, H.; Kumarendran, M.; Brandon, Z.; Kirtley, S.; Hemelaar, J. Adverse perinatal outcomes associated with HAART and monotherapy: Systematic review and meta-analysis. AIDS 2022, 36, 1409–1427. [Google Scholar] [CrossRef] [PubMed]
- Arab, K.; Spence, A.R.; Czuzoj-Shulman, N.; Abenhaim, H.A. Pregnancy outcomes in HIV-positive women: A retrospective cohort study. Arch. Gynecol. Obstet. 2017, 295, 599–606. [Google Scholar] [CrossRef] [PubMed]
- Tukei, V.J.; Hoffman, H.J.; Greenberg, L.; Thabelo, R.; Nchephe, M.; Mots’oane, T.; Masitha, M.; Chabela, M.; Mokone, M.; Mofenson, L.; et al. Adverse Pregnancy Outcomes Among HIV-positive Women in the Era of Universal Antiretroviral Therapy Remain Elevated Compared With HIV-negative Women. Pediatr. Infect. Dis. J. 2021, 40, 821–826. [Google Scholar] [CrossRef] [PubMed]
- Kenny, J.; Williams, B.; Prime, K.; Tookey, P.; Foster, C. Pregnancy outcomes in adolescents in the UK and Ireland growing up with HIV. HIV Med. 2012, 13, 304–308. [Google Scholar] [CrossRef]
- Elgalib, A.; Hegazi, A.; Samarawickrama, A.; Roedling, S.; Tariq, S.; Draeger, E.; Hemelaar, J.; Rathnayaka, T.; Azwa, A.; Hawkins, D.; et al. Pregnancy in HIV-infected teenagers in London. HIV Med. 2011, 12, 118–123. [Google Scholar] [CrossRef]
- Toska, E.; Cluver, L.; Laurenzi, C.A.; Wittesaele, C.; Sherr, L.; Zhou, S.; Langwenya, N. Reproductive aspirations, contraception use and dual protection among adolescent girls and young women: The effect of motherhood and HIV status. J. Int. AIDS Soc. 2020, 23, 118–123. [Google Scholar] [CrossRef]
- Ramraj, T.; Jackson, D.; Dinh, T.H.; Olorunju, S.; Lombard, C.; Sherman, G.; Puren, A.; Ramokolo, V.; Noveve, N.; Singh, Y.; et al. Adolescent Access to Care and Risk of Early Mother-to-Child HIV Transmission. J. Adolesc. Health 2018, 62, 434–443. [Google Scholar] [CrossRef] [Green Version]
- Pons-Duran, C.; Casellas, A.; Bardají, A.; Valá, A.; Sevene, E.; Quintó, L.; Macete, E.; Menéndez, C.; González, R. Adolescent, Pregnant, and HIV-Infected: Risk of Adverse Pregnancy and Perinatal Outcomes in Young Women from Southern Mozambique. J. Clin. Med. 2021, 10, 1564. [Google Scholar] [CrossRef]
- Murphy, E.; Keller, J.; Argani, C.; Milio, L.; Powell, A.; Sheffield, J.; Agwu, A.; Anderson, J. Pregnancy in an Urban Cohort of Adolescents Living with Human Immunodeficiency Virus: Characteristics and Outcomes in Comparison to Adults. AIDS Patient Care STDS 2021, 35, 103–109. [Google Scholar] [CrossRef]
- Zhang, Z. Propensity score method: A non-parametric technique to reduce model dependence. Ann. Transl. Med. 2017, 5, 7. [Google Scholar] [CrossRef] [Green Version]
- Benedetto, U.; Head, S.J.; Angelini, G.D.; Blackstone, E.H. Statistical primer: Propensity score matching and its alternatives. Eur. J. Cardiothorac. Surg. 2018, 53, 1112–1117. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kane, L.T.; Fang, T.; Galetta, M.S.; Goyal, D.K.C.; Nicholson, K.J.; Kepler, C.K.; Vaccaro, A.R.; Schroeder, G.D. Propensity Score Matching: A Statistical Method. Clin. Spine Surg. 2020, 33, 120–122. [Google Scholar] [CrossRef] [PubMed]
- Von Elm, E.; Altman, D.G.; Egger, M.; Pocock, S.J.; Gøtzsche, P.C.; Vandenbroucke, J.P. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies. PLoS Med. 2007, 4, e296. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chen, X.-K.; Wen, S.W.; Fleming, N.; Demissie, K.; Rhoads, G.G.; Walker, M. Teenage pregnancy and adverse birth outcomes: A large population based retrospective cohort study. Int. J. Epidemiol. 2007, 36, 368–373. [Google Scholar] [CrossRef] [Green Version]
- Althabe, F.; Moore, J.L.; Gibbons, L.; Berrueta, M.; Goudar, S.S.; Chomba, E.; Derman, R.J.; Patel, A.; Saleem, S.; Pasha, O.; et al. Adverse maternal and perinatal outcomes in adolescent pregnancies: The Global Network’s Maternal Newborn Health Registry study. Reprod. Health 2015, 12, S8. [Google Scholar] [CrossRef]
- Zhang, T.; Wang, H.; Wang, X.; Yang, Y.; Zhang, Y.; Tang, Z.; Wang, L. The adverse maternal and perinatal outcomes of adolescent pregnancy: A cross sectional study in Hebei, China. BMC Pregnancy Childbirth 2020, 20, 339. [Google Scholar] [CrossRef]
- Kassa, G.M.; Arowojolu, A.O.; Odukogbe, A.A.; Yalew, A.W. Adverse neonatal outcomes of adolescent pregnancy in Northwest Ethiopia. PLoS ONE 2019, 14, e0218259. [Google Scholar] [CrossRef] [Green Version]
- Brocklehurst, P.; French, R. The association between maternal HIV infection and perinatal outcome: A systematic review of the literature and meta-analysis. BJOG An. Int. J. Obstet. Gynaecol. 1998, 105, 836–848. [Google Scholar] [CrossRef]
- Wedi, C.O.O.; Kirtley, S.; Hopewell, S.; Corrigan, R.; Kennedy, S.H.; Hemelaar, J. Perinatal outcomes associated with maternal HIV infection: A systematic review and meta-analysis. Lancet HIV 2016, 3, e33–e48. [Google Scholar] [CrossRef]
- Piske, M.; Qiu, A.Q.; Maan, E.J.; Sauvé, L.J.; Forbes, J.C.; Alimenti, A.; Janssen, P.A.; Money, D.M.; Côté, H.C.F. Preterm Birth and Antiretroviral Exposure in Infants HIV-exposed Uninfected. Pediatr. Infect. Dis. J. 2021, 40, 245–250. [Google Scholar] [CrossRef]
- Albert, A.Y.K.; Elwood, C.; Wagner, E.C.; Pakzad, Z.; Chaworth-Musters, T.; Berg, K.; Van Schalkwyk, J.; Maan, E.J.; Azampanah, A.; McClymont, E.; et al. Investigation of factors associated with spontaneous preterm birth in pregnant women living with HIV. AIDS 2020, 34, 719–727. [Google Scholar] [CrossRef] [PubMed]
- Fentie, E.A.; Yeshita, H.Y.; Bokie, M.M. Low birth weight and associated factors among HIV positive and negative mothers delivered in northwest Amhara region referral hospitals, Ethiopia, 2020 a comparative crossectional study. PLoS ONE 2022, 17, e0263812. [Google Scholar] [CrossRef] [PubMed]
- Lambert, J.S.; Watts, D.H.; Mofenson, L.; Stiehm, E.R.; Harris, D.R.; Bethel, J.; Whitehouse, J.; Jimenez, E.; Gandia, J.; Scott, G.; et al. Risk factors for preterm birth, low birth weight, and intrauterine growth retardation in infants born to HIV-infected pregnant women receiving zidovudine. AIDS 2000, 14, 1389–1399. [Google Scholar] [CrossRef] [PubMed]
- Slyker, J.A.; Patterson, J.; Ambler, G.; Richardson, B.A.; Maleche-Obimbo, E.; Bosire, R.; Mbori-Ngacha, D.; Farquhar, C.; John-Stewart, G. Correlates and outcomes of preterm birth, low birth weight, and small for gestational age in HIV-exposed uninfected infants. BMC Pregnancy Childbirth 2014, 14, 7. [Google Scholar] [CrossRef] [Green Version]
- Badell, M.L.; Lindsay, M. Thirty years later: Pregnancies in females perinatally infected with human immunodeficiency virus-1. AIDS Res. Treat. 2012, 2012, 418630. [Google Scholar] [CrossRef]
- Koenig, L.J.; Espinoza, L.; Hodge, K.; Ruffo, N. Young, seropositive, and pregnant: Epidemiologic and psychosocial perspectives on pregnant adolescents with human immunodeficiency virus infection. Am. J. Obstet. Gynecol. 2007, 197, S123–S131. [Google Scholar] [CrossRef]
- Ntombela, N.P.; Kharsany, A.B.M.; Soogun, A.; Yende-Zuma, N.; Baxter, C.; Kohler, H.P.; McKinnon, L.R. Viral suppression among pregnant adolescents and women living with HIV in rural KwaZulu-Natal, South Africa: A cross sectional study to assess progress towards UNAIDS indicators and Implications for HIV Epidemic Control. Reprod. Health 2022, 19, 116. [Google Scholar] [CrossRef]
- Haider, M.R.; Brown, M.J.; Harrison, S.; Yang, X.; Ingram, L.D.; Bhochhibhoya, A.; Hamilton, A.; Olatosi, B.; Li, X. Sociodemographic factors affecting viral load suppression among people living with HIV in South Carolina. AIDS Care 2021, 33, 290–298. [Google Scholar] [CrossRef]
- Wyk BVan Kriel, E.; Mukumbang, F. Retention in care for adolescents who were newly initiated on antiretroviral therapy in the Cape Metropole in South Africa. South. Afr. J. HIV Med. 2020, 21, 1077. [Google Scholar]
- World Health Organization. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach; World Health Organization: Geneva, Switzerland, 2013.
- Hess, K.L.; Hall, H.I. HIV Viral Suppression, 37 States and the District of Columbia, 2014. J. Community Health 2018, 43, 338. [Google Scholar] [CrossRef]
- Lundberg, P.; Andersson, R.; Machado, E.S.; Costa TP da Hofer, C.B. Pregnancy outcomes in young mothers with perinatally and behaviorally acquired HIV infections in Rio de Janeiro. Braz. J. Infect. Dis. 2018, 22, 412–417. [Google Scholar] [CrossRef] [PubMed]
- Centers for Disease Control and Prevention. HIV Surveillance Report. 2020; Volume 33. Available online: http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html (accessed on 2 March 2023).
- Jackson-Gibson, M.; Zash, R.; Mussa, A.; Caniglia, E.C.; Diseko, M.; Mayondi, G.; Mabuta, J.; Morroni, C.; Mmalane, M.; Lockman, S.; et al. High risk of adverse birth outcomes among adolescents living with HIV in Botswana compared to adult women living with HIV and adolescents without HIV. BMC Pregnancy Childbirth 2022, 22, 372. [Google Scholar] [CrossRef] [PubMed]
- Austin, P.C.; Xin Yu, A.Y.; Vyas, M.V.; Kapral, M.K. Applying Propensity Score Methods in Clinical Research in Neurology. Neurology 2021, 97, 856–863. [Google Scholar] [CrossRef] [PubMed]
- Ahmed, A.; Rosella, L.C.; Oskoui, M.; Watson, T.; Yang, S. In Utero Exposure to Maternal Injury and the Associated Risk of Cerebral Palsy. JAMA Pediatr. 2023, 177, 53–61. [Google Scholar] [CrossRef]
- Birth Prevalence of Cerebral Palsy|CDC. Available online: https://www.cdc.gov/ncbddd/cp/features/birth-prevalence.html (accessed on 26 February 2023).
- Boyle, E.M.; Poulsen, G.; Field, D.J.; Kurinczuk, J.J.; Wolke, D.; Alfirevic, Z.; Quigley, M.A. Effects of gestational age at birth on health outcomes at 3 and 5 years of age: Population based cohort study. BMJ 2012, 344, e896. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Fanaroff, A.A.; Stoll, B.J.; Wright, L.L.; Carlo, W.A.; Ehrenkranz, R.A.; Stark, A.R.; Bauer, C.R.; Donovan, E.F.; Korones, S.B.; Laptook, A.R.; et al. Trends in neonatal morbidity and mortality for very low birthweight infants. Am. J. Obstet. Gynecol. 2007, 196, 147.e1–147.e8. [Google Scholar] [CrossRef]
- Tovo, P.A.; De Martino, M.; Gabiano, C.; Galli, L.; Cappello, N.; Ruga, E.; Tulisso, S.; Vierucci, A.; Loy, A.; Zuccotti, G.V. Mode of delivery and gestational age influence perinatal HIV-1 transmission. J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. 1996, 11, 88–94. [Google Scholar] [CrossRef]
- Kuhn, L.; Steketee, R.W.; Weedon, J.; Abrams, E.J.; Lambert, G.; Bamji, M.; Schoenbaum, E.; Farley, J.; Nesheim, S.R.; Palumbo, P.; et al. Distinct Risk Factors for Intrauterine and Intrapartum Human Immunodeficiency Virus Transmission and Consequences for Disease Progression in Infected Children. J. Infect. Dis. 1997, 179, 52–60. [Google Scholar] [CrossRef] [Green Version]
- Mirpuri, J.; Jain, L. Issues of prematurity and HIV infection. Clin. Perinatol. 2010, 37, 887–905. [Google Scholar] [CrossRef]
- Nuwagaba-Biribonwoha, H.; Kiragga, A.N.; Yiannoutsos, C.T.; Musick, B.S.; Wools-Kaloustian, K.K.; Ayaya, S.; Wolf, H.; Lugina, E.; Ssali, J.; Abrams, E.J.; et al. Adolescent pregnancy at antiretroviral therapy (ART) initiation: A critical barrier to retention on ART. J. Int. AIDS Soc. 2018, 21, e25178. [Google Scholar] [CrossRef]
- Da Silva Calvo, K.; Knauth, D.R.; Hentges, B.; Leal, A.F.; da Silva, M.A.; Silva, D.L.; Vasques, S.C.; Hamester, L.; da Silva, D.A.; Dorneles, F.V.; et al. Factors associated with loss to follow up among HIV-exposed children: A historical cohort study from 2000 to 2017, in Porto Alegre, Brazil. BMC Public Health 2022, 22, 1422. [Google Scholar] [CrossRef] [PubMed]
- Levin, L.; Henry-Reid, L.; Murphy, D.A.; Peralta, L.; Sarr, M.; Ma, Y.; Rogers, A.S. Adolescent Medicine HIV/AIDS Research Network. Incident Pregnancy Rates in HIV Infected and HIV Uninfected at-Risk Adolescents. J. Adolesc. Health 2001, 29 (Suppl. 3), 101–108. [Google Scholar] [CrossRef] [PubMed]
- Finocchario-Kessler, S.; Sweat, M.D.; Dariotis, J.K.; Anderson, J.R.; Jennings, J.M.; Keller, J.M.; Vyas, A.A.; Trent, M.E. Childbearing motivations, pregnancy desires, and perceived partner response to a pregnancy among urban female youth: Does HIV-infection status make a difference? AIDS Care 2012, 24, 1–11. [Google Scholar] [CrossRef] [PubMed]
- Gigante, D.P.; de França, G.V.A.; De Lucia Rolfe, E.; Lima, N.P.; dos Santos Motta, J.V.; Gonçalves, H.; Horta, B.L.; Barros, F.C.; Ong, K.K. Adolescent parenthood associated with adverse socioeconomic outcomes at age 30 years in women and men of the Pelotas, Brazil: 1982 Birth Cohort Study. BJOG 2019, 126, 360. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kourtis, A.P.; Mirza, A.; Committee on Pediatrics AIDS. Contraception for HIV-Infected Adolescents. Pediatrics 2016, 138, e20161892. [Google Scholar] [CrossRef] [PubMed] [Green Version]
APW-HIV-Positive (n = 15) | APW-HIV-Negative (n = 45) | p 1 | PW-HIV (n = 45) | p 2 | |
---|---|---|---|---|---|
Variables | Cases/Total Available (%) | Cases/Total Available (%) | Cases/Total Available (%) | ||
Age, years, median (min–max) | 16 (13–17) | 16 (13–17) | 0.720 | 29 (19–42) | <0.001 |
BMI, kg/m2, average (±SD) | 23.1 (±2.3) | 22.8 (±2.1) | 0.691 | 22.5 (±2.2) | 0.420 |
Nulliparous, n (%) | 15/15 (100%) | 43/45 (95.6%) | 1.0 | 23/45 (51.1%) | 0.001 |
Stable partnership, n (%) | 3/14 (21.4%) | 12/45 (26.7%) | 1.0 | 28/45 (62.2%) | 0.008 |
Planned pregnancy, n (%) | 1/14 (7.1%) | 8/45 (17.8%) | 0.671 | 6/43 (14%) | 0.669 |
Smoking, n (%) | 2/14 (14.3%) | 9/45 (20%) | 1.0 | 13/44 (29.5%) | 0.317 |
Drugs, n (%) | 2/14 (14.3%) | 1/42 (2.4%) | 0.151 | 8/44 (18.2%) | 1.0 |
GA at first appointment, weeks, average (± SD) | 17.4 (±7.5) | 17.9 (±6.8) | 0.827 | 15.8 (±7.2) | 0.669 |
Syphilis, n (%) | 0/15 | 0/44 | - | 3/45 (6.7%) | 0.566 |
APW-HIV-Positive (n = 15) | PW-HIV (n = 45) | p | |
---|---|---|---|
Variables | Cases/Total Available (%) | Cases/Total Available (%) | |
Time of HIV infection, years, median (min–max) | 16.0 (4–17) | 10 (0–22) | 0.021 |
Perinatally acquired HIV infection, n (%) | 13/15 (86.7%) | 11/45 (24.4%) | <0.001 |
Time of ART, years, median (min–max) | 13.5 (0–16) | 3.5 (0–21) | 0.034 |
Previous opportunistic infection, n (%) | 2/13 (15.4%) | 13/45 (28.9%) | 0.480 |
Opportunistic infection in pregnancy, n (%) | 0/15 | 4/45 (8.9%) | 0.564 |
Baseline CD4+ cell count, /mm (3), median (min–max) | 546 (80–1288) | 399 (13–1503) | 0.067 |
Undetectable baseline VL, n (%) | 3/14 (21.4%) | 17/42 (40.5%) | 0.198 |
VL levels baseline, log, mean (±SD) 1 | 2.9 (±1.8) | 3.7 (±0.9) | 0.150 |
CD4+ cell count at 34 weeks, /mm (3), median (min–max) | 512.5 (160–1103) | 542 (17–1280) | 0.686 |
Undetectable VL at 34 weeks, n (%) | 7/14 (50%) | 29/40 (72.5%) | 0.188 |
VL levels at 34 weeks, log, mean (± SD) 1 | 1.5 (±1.8) | 3.2 (±1.3) | 0.014 |
APW-HIV-Positive (n = 15) | APW-HIV-Negative (n = 45) | p 1 | PW-HIV (n = 45) | p 2 | |
---|---|---|---|---|---|
Variables | Cases/Total Available (%) | Cases/Total Available (%) | Cases/Total Available (%) | ||
GA at delivery, weeks, median (min–max) | 37.6 (36.3–38.6) | 39.0 (32.2–40.3) | 0.001 | 37.6 (22.1–40) | 0.955 |
Birth weight, gram, median (min–max) | 2600 (2380–3140) | 3100 (1520–4318) | 0.002 | 2900 (500–3750) | 0.201 |
Vaginal delivery, n (%) | 0/14 | 30/45 (66.7%) | <0.001 | 2/43 (4.7%) | 1.0 |
Pre-eclampsia, n (%) | 0/15 | 3/45 (6.7%) | 1.0 | 1/44 (2.3%) | 1.0 |
Preterm labor, n (%) | 1/14 (7.1%) | 2/45 (4.4%) | 0.564 | 5/44 (11.4%) | 1.0 |
Composite endpoint of adverse perinatal outcomes, n (%) | 6/14 (42.9%) | 6/45 (13.3%) | 0.026 | 13/44 (29.5%) | 0.514 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Osmundo Junior, G.d.S.; Cabar, F.R.; Peres, S.V.; Waissman, A.L.; Galletta, M.A.K.; Francisco, R.P.V. Adverse Perinatal Outcomes among Adolescent Pregnant Women Living with HIV: A Propensity-Score-Matched Study. Int. J. Environ. Res. Public Health 2023, 20, 5447. https://doi.org/10.3390/ijerph20085447
Osmundo Junior GdS, Cabar FR, Peres SV, Waissman AL, Galletta MAK, Francisco RPV. Adverse Perinatal Outcomes among Adolescent Pregnant Women Living with HIV: A Propensity-Score-Matched Study. International Journal of Environmental Research and Public Health. 2023; 20(8):5447. https://doi.org/10.3390/ijerph20085447
Chicago/Turabian StyleOsmundo Junior, Gilmar de Souza, Fábio Roberto Cabar, Stela Verzinhasse Peres, Adriana Lippi Waissman, Marco Aurélio Knippel Galletta, and Rossana Pulcineli Vieira Francisco. 2023. "Adverse Perinatal Outcomes among Adolescent Pregnant Women Living with HIV: A Propensity-Score-Matched Study" International Journal of Environmental Research and Public Health 20, no. 8: 5447. https://doi.org/10.3390/ijerph20085447
APA StyleOsmundo Junior, G. d. S., Cabar, F. R., Peres, S. V., Waissman, A. L., Galletta, M. A. K., & Francisco, R. P. V. (2023). Adverse Perinatal Outcomes among Adolescent Pregnant Women Living with HIV: A Propensity-Score-Matched Study. International Journal of Environmental Research and Public Health, 20(8), 5447. https://doi.org/10.3390/ijerph20085447