Objective: We evaluated the prevalence of de novo hypertensive disorders of pregnancy (dnHDP) in pregnant people with HIV (PPHIV) in the Western Cape Province, South Africa in 2018-2019 by HIV and antiretroviral therapy (ART) status.
Methods: All people with a pregnancy outcome from 01/01/2018-31/12/2019 in the Western Cape Provincial Health Data Centre (WCPHDC) were included. The WCPHDC integrates data from multiple electronic platforms according to unique identifiers. dnHDP was classified by ICD-10 code or first-time prescription of antihypertensive drugs <140 days before delivery. Pregnant people with pre-existing hypertension without superimposed pre-eclampsia/eclampsia were not considered to have dnHDP. Adjusted prevalence ratios (aPR) for dnHDP by HIV/ART status were calculated using Poisson regression with robust variance.
Results: Among 180,553 pregnant people studied, 13,677 (7.6%) had dnHDP and 33,978 (18.8%) were PPHIV. Among PPHIV, 11.3% (N = 3,827) had no evidence of ART, 59.7% (N = 20,283) initiated ART preconception and 29.0% (N = 9,868) had ART initiated during pregnancy. Compared to those without HIV (7.7%), dnHDP prevalence was lower in PPHIV with preconception (6.9%; aPR 0.78; 95% CI 0.74-0.83) or pregnancy-initiated ART (7.0%; aPR 0.83; 95% CI 0.75-0.92) and higher in PPHIV without ART (9.8%; aPR 1.17; 95% CI 1.06-1.29) adjusted for maternal age, multiparity, multi-gestation pregnancy and pre-existing hypertension. ART duration by delivery of ≥100 weeks versus pregnancy-initiated ART of 20-<40 weeks was protective (aPR 0.88; 95% CI 0.78-0.98).
Conclusions: In the context of universal ART, these findings are reassuring for most PPHIV. ART was not associated with increased dnHDP prevalence and longer ART duration was protective.