{"paper_id":"18c6b4b6-6bf7-424a-8934-df0a65c9304b","body_text":"Impact of Maternal HIV Infection on Pregnancy and Labour Complication and Perinatal Health Outcomes: A South African Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Maternal HIV Infection on Pregnancy and Labour Complication and Perinatal Health Outcomes: A South African Retrospective Study Zinhle Mlambo, Sapna Ramdin, Randolph Green-Thompson, Jagidesa Moodley, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7508995/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Feb, 2026 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted 9 You are reading this latest preprint version Abstract Background: Maternal HIV infection is associated with increased risks of pregnancy complications and adverse perinatal outcomes, particularly in high-prevalence settings like South Africa. The COVID-19 pandemic disrupted healthcare access, potentially exacerbating challenges in antenatal care and HIV management. To our knowledge, limited South African data exists regarding the impact of maternal HIV on birth complications and perinatal birth outcomes especially during the COVID-19 pandemic. Aim: This study thus evaluates the impact of maternal HIV on pregnancy and perinatal outcomes before and during the COVID-19 pandemic using archived chart records from a tertiary hospital in KwaZulu-Natal, South Africa. Methods: A retrospective analysis of 8,463 birth records from March 2019 to December 2020 was conducted, categorized into pre-pandemic and pandemic periods. Data were stratified by maternal HIV status and analyzed for demographics, antenatal care attendance, ART regimens, labor characteristics, and birth outcomes. Statistical tests including chi-square and logistic regression were used to assess associations between HIV status and outcomes. Results: Hospital attendance declined during the pandemic, especially among HIV-infected women. HIV-positive women were predominantly aged 19–35, multigravida, and multiparous. Antenatal care attendance was suboptimal and worsened during the pandemic. ART coverage remained high with maintained viral suppression. HIV-positive women had shorter active labor and higher elective cesarean rates during the pandemic. Preterm birth risk was higher pre-pandemic among HIV-positive women but not significantly different during the pandemic. Birth weights were lower in HIV-exposed infants pre-pandemic with a non-significant shift during the pandemic. Sepsis incidence increased among HIV-infected women during the pandemic. No maternal deaths were reported. Conclusion: The COVID-19 pandemic significantly disrupted prenatal and HIV care for pregnant women, but effective HIV management maintained some protective effects. Maternal HIV remains a critical factor influencing birth outcomes, necessitating sustained focus on tailored care during crises to protect vulnerable populations. COVID–19 human immunodeficiency virus (HIV) perinatal birth outcomes pregnancy complication Introduction Globally, 40.8 million people were reported to be living with human immunodeficiency virus (HIV) in 2024, of which [ 1 ] 53% were females, and of reproductive age [ 1 ]. HIV infection is a major contributor to maternal mortality and morbidity, especially in low– and middle–income countries (LMIC), particularly Sub-Saharan Africa [ 2 ] and southern Asia [ 3 ]. Pregnant women living with HIV have 2–10 times increased risk of death during pregnancy and the postpartum period compared with uninfected pregnant women [ 4 , 5 ]. South Africa (SA) remains the epicentre of HIV infection, with approximately 8 million people living with HIV (PLHIV) [ 1 ]. Of note, in 2020 it was reported that one in three pregnant women receiving antenatal care in SA is HIV infected [ 6 ].This infectivity rate accounts for 27.5% of most early-maternal deaths in SA, second to hypertensive disorders of pregnancy (HDPs) [ 6 , 7 ]. Maternal HIV infection is also associated with increased pregnancy complications and higher risk of adverse perinatal outcomes including low birth weight (LBW:< 2500g) and perinatal and early neonatal mortality [ 8 – 10 ]. The effect of antiretroviral therapy (ART) on this association remains unclear [ 11 ].It is well established that ART improves the overall health and quality of life for PLHIV and reduces the rate of mother–to–child transmission [ 12 – 14 ]. However, its use during pregnancy may be associated with preterm birth, stillbirth, and fetal growth restriction, depending on ART regimen and the timing of initiation [ 15 – 17 ]. Despite the immediate rollout of the World Health Organisation (WHO) Option B + strategic initiation of lifelong ART to all South African pregnant and breastfeeding women living with HIV, regardless of HIV staging or CD4 + count [ 18 , 19 ] HIV remains the primary cause of morbidity and mortality for children under 5 years [ 20 , 21 ]. In SA, the maternal and perinatal mortality and morbidity burden was further compounded by the COVID–19 pandemic [ 22 , 23 ]. Additionally, the nationwide lockdown implemented between March 2020 and July 2022 due to rapid community transmission of SARS CoV–2, resulted in disruptions in daily transportationreduced community services and healthcare access [ 24 , 25 ]. This subsequently created difficulties in managing chronic diseases such as HIV, diabetes and hypertension; negatively impacting maternal and perinatal health, particularly those affected with HIV[ 26 ]. To our knowledge, limited South African data exists regarding the impact of maternal HIV on birth complications and perinatal birth outcomes especially during the COVID-19 pandemic. In view of this, we evaluated the effect of maternal HIV infection on pregnancy complications and perinatal health outcomes using archived data from a local tertiary hospital in KwaZulu-Natal. Materials and methods Ethical appoval This study was approved by the Institutional Research Ethics Committee, Durban University of Technology (IREC 054/22). The was no direct patient involvement during data collection as only archived data records were used. Study details This retrospective study was a primary analysis of birth registry data extracted from a local tertiary affiliated hospital in KwaZulu-Natal, South Africa. Only data between 1 March 2019 and 31 December 2020 were included irrespective of maternal health status or perinatal birth outcomes. All recorded data were manually extracted and thereafter coded for statistical analysis. Most outcomes and covariates were directly extracted from structured data fields within the birth registry record. Data was compared based on time periods categorized as pre - COVID–19 (March 2019 – February 2020) and during the COVID–19 (March 2020 – Dec 2020) pandemic. All data were sub-categorised according to HIV status (HIV–negative and HIV–positive); age (< 18, 19– 35 and > 35 years old); gravidity (primigravida or multigravida); parity (nulliparous, primiparous and multiparous); and gestational age (at birth as < 37 weeks and ≥ 37 weeks), respectively. Antenatal care (ANC) bookings were classified as < 20 weeks and > 20 weeks; and number of ANC visits as < 8 and ≥ 8, respectively. ART treatment was categorised as either untreated, fixed-dose combination (FDC) or triple ART treatment, whereas viral load as LTDL (undetectable), ≤ 1000 (suppressed), > 1000 (unsuppressed) and > 10 000 copies, respectively. Mode of delivery was categorised as vaginal birth (normal vertex) and caesarean section (CS), with CS further sub-categorized as emergency CS and elective CS, respectively. Regarding labour, the followingcategories were analysed, viz., follows, vacuum utilization, forceps utilization, breech presentation, miscarriage, induction of labour, antepartum haemorrhage, postpartum haemorrhage, preeclampsia (PE), eclampsia, sepsis and obstructed and/or prolonged labour. Perinatal health outcomes were categorised as live and stillbirths, with stillbirths sub-categorised as macerated stillbirth (MSB) and fresh stillbirth (FSB). The APGAR (5 min) and (10 min) scores were categorised as low (0–3), intermediate (4–6) and normal (7–10). The variables “resuscitate bag and mask utilization”, “neonatal birth defects”,“birth defects defined”, Nevirapine (NVP) and daily NVP administration were categorised as “yes”, “no” and “non-applicable (N/A)” respectively. Statistical Analysis All data was analysed using STATA (version 12, STATACORP) and GraphPad Prism 5. The data was assessed for normality using the skewness and kurtosis normality test. All continuous data are summarized as means and standard deviation. The unpaired t-test was used to compare the means for maternal age, gravidity, parity and gestational age between the pre-COVID–19 and COVID–19 pandemic time periods. Categorical data are presented as frequency and percentages, and the Pearson’s chi-squared test was used to determine bivariate associations between demographic and clinical variables stratified by time (i.e., pre-COVID–19 and during the pandemic). Binary logistic regression was used to determine the relationship between HIV status and gestational age at birth, caesarean section delivery, stillbirth, birth weight and 5- and 10-minute APGAR scores during both time periods. A 95% confidence interval (CI) was used and p < 0.05 was considered statistically significant. Results Maternal characteristics The demographic and clinical profiles of the study population are shown in Table 1 . Of the 8,463 records analysed, 4,861 pregnant women attended the hospital prior to the pandemic, versus 3,603 during the pandemic and/or national lockdown. Of those who attended during the pandemic (pre-COVID), 1,849 were HIV-infected; this number declined (n = 1,407) during the pandemic.Noteworthy, significant statistical differences were observed for maternal age, gravidit y and parity categories ( p < 0.001) between the two periods analysed. Amongst the HIV-infected women who accessed the hospital pre- and during COVID-19, the majority were aged between 19–35 years (77.09% vs 74.96%), multigravida (85.97% vs 84.87%) and multiparous (55.59% vs 50.97%). A similar trend was observed amongst the HIV-uninfected women for age and gravidity, however, for parity, nulliparous (39.38% vs 43.45%) was dominant in both time periods. A noticeable decline was noted in the number of ANC bookings made prior to twenty weeks of gestation by HIV positive women versus HIV uninfected women during both time periods (pre-COVID-19 1,415 vs 885; pandemic 1,083 vs 690), albeit non-significant. Notably, the average number of ANC visits were less than eight regardless of HIV status or the time periods analysed. Only 330 (11.21%) HIV uninfected women attended more than eight ANC visits before the pandemic. For HIV–infected women, 245 (13.56%) accessed more than eight ANC visits and this access decreased during the pandemic (n = 144; 10.79%). Table 1 Demographic and clinical profiles stratified by study period (pre-COVID-19 and during COVID-19) and HIV status Pre-COVID–19 (n = 4853) COVID–19 (n = 3606) HIV Status p – value HIV Status p – value Negative (n = 2984) Positive (n = 1842) Negative (n = 2188) Positive (n = 1142) Age < 18 454 (15.21%) 50 (2.71%) < 0.001* 348 (15.90%) 88 (6.2%) < 0.001* 19–35 2,315 (77.58%) 1,420 (77.09%) 1,638 (74.86%) 1,052 (74.96%) > 35 215 (7.21%) 372 (20.20%) 202 (9.23%) 2.63 (18.75%) Gravidity Primigravida 1,203 (40.06%) 259 (14.03%) < 0.001* 922 (42.43%) 211 (15.13%) < 0.001* Multigravida 1,800 (59.94%) 1,587 (85.97%) 1,251 (57.57%) 1,184 (84.87%) Parity Nulliparous 1,174 (39.38%) 264 (14.33%) < 0.001* 942 (43.45%) 207 (14.88%) < 0.001* Primiparous 904 (30.33%) 554 (30.08%) 630 (29.06%) 475 (34.15%) Multiparous 903 (30.29%) 1,024 (55.59%) 596 (27.49%) 709 (50.97%) ANC booking < 20 weeks 1,415 (48.24%) 885 (48.76%) 0.31 1,083 (50.61%) 690 (50.07%) 0.57 > 20 weeks 1,518 (51.76%) 930 (51.24%) 1,057 (49.39%) 688 (49.93%) No of ANC visits < 8 2,613 (88.79%) 1,562 (86.44%) 0.05* 1,904 (88.97%) 1,191 (89.21%) 0.82 ≥8 330 (11.21%) 245 (13.56%) 380 (10.92%) 144 (10.79%) On ART Untreated - 56 (3.05%) - 65 (4.62%) < 0.001* FDC - 102 (5.55%) - 133 (9.45%) Triple - 1,679 (91.40%) - 1,209 (85.93%) Viral load Undetectable - 490 (55.12%) - 221 (55.25%) 0.01* ≤ 1000 copies - 288 (32.40%) - 150 (37.50%) > 1000 copies - 60 (6.75%) - 10 (2.50%) > 10 000 copies - 51 (5.74%) - 19 (4.75%) Gestational age at birth < 37 weeks 601 (20.07% 437 (23.70%) 0.04* 537 (24.53%) 360 (25.59%) 0.66 ≥ 37 weeks 2,392 (79.93%) 1,407 (76.30%) 1,652 (75.47%) 1,047 (74.41%) A significant difference was noted in the number of HIV–positive women who were on ART during both time periods ( p < 0.001). Of note, most women were on either dual (FDC) (5.55%) or triple (91.40%) ART prior to the pandemic, whereas during the pandemic, only 133 (9.45%) were managed on FDC and 1209 (85.93%) on triple ART. Regrettably, a small percentage of HIV–positive women were not managed on any form of ART prior (3.05%) to or during (4.62%) the pandemic. Noteworthy, viral loads of > 1000 copies in this cohort was lower (6.75%) during the pandemic compared to prior (2.50%). Likewise, 5.74% of this cohort demonstrated > 10 000 copies during the pandemic versus 4.75%. Most deliveries occurredat ≥ 37 weeks regardless of the time periods analysed. However prior to the pandemic, pre-term (< 37 weeks) deliveries were higher recorded amongst HIV uninfected (n = 601) versus infected women (n = 437; p < 0.05). A similar trend was noted during the pandemic (537 uninfected vs 360 HIV infected). Labour and birth outcomes The labour and birth outcomes for the study population are shown in Table 2 . The duration of active labour was shorter amongst the HIV infected versus the uninfected women prior to (8.11 ± 4.64 vs 9.12 ± 4.51; p < 0.001) and during (8.57 ± 4.28 vs 9.28 ± 4.63; p < 0.005) the pandemic. DDuring the pandemic, lower rates of normal vertex (47.97% vs 51.43%) and emergency CS (40.51% vs 42.40%) deliveries was observed in HIV infected women versus pre-COVID-19. As expected, elective CS deliveries increased during the pandemic in both HIV-infected (6.17% vs 11.51%) and uninfected (6.44% vs 9.56%) women compared to pre-COVID. Notably, low rates were noted forvacuum utilization during both time periods, with a slight decrease in HIV infected vs HIV-uninfected women (0.07% vs 0.18) during the pandemic. The use of forceps in supporting the delivery was higher in HIV uninfected versus HIV-infected women during the pandemic (1.15% vs 0.07%; p = 0.001). During the pandemic, a reduction was observed in breach presentation (0.08% vs 0.68%), induction of labour (1.71% vs 3.69%) and miscarriage (0.22% vs 0.33%) in the HIV infected women compared to prior. Fortunately, no maternal deaths were recorded during both time periods. The number of live births was decreased in both HIV-infected (1,773 vs 1,333) and uninfected (2,909 vs 2,079) women during both time periods analysed. Prior to the pandemic, similar reductions were noted for stillbirths in both HIV-infected (n = 57 vs 47) and uninfected (n = 72 vs 59) women compared to during the pandemic. Table 2 Labour and birth outcomes of the study population stratified by study period (pre-COVID-19 and during COVID-19) and HIV status Labour and birth outcomes Pre-COVID–19 (n=4853) COVID–19 (n=3606) HIV Status p – value HIV Status p – value Negative (n=2984) Positive (n=1842) Negative (n=2188) Positive (n=1142) Duration of active labour (mean, SD) 9.12 (4.51) 8.11 (4.64) <0.001* 9.28 (4.63) 8.57 (4.28) 0.004* Mode of birth Normal vertex 1,536 (51.01%) 951 (51.43%) 0.82 1,063 (48.41%) 675 (47.97%) 0.16 Emergency CS 1,281 (42.54%) 784 (42.40%) 923 (42.03%) 570 (40.51%) Elective CS 194 (6.44%) 114 (6.17%) 210 (9.56%) 162 (11.51%) Vacuum utilization 1 (0.03%) 0 (0.00%) <0.001* 4 (0.18%) 1 (0.07%) 0.68 Forceps utilization 10 (0.34%) 7 (0.39%) 0.94 25 (1.15%) 1 (0.07%) 0.001* Breech presentation 13 (0.45%) 12 (0.68%) 0.56 2 (0.09%) 1 (0.08%) 0.99 Induction of Labour 115 (3.84%) 68 (3.69%) 0.88 45 (2.06%) 24 (1.71%) 0.75 Miscarriage 6 (0.21%) 6 (0.33%) 0.68 2 (0.09%) 3 (0.22%) 0.62 Maternal Death 0 (0.00%) 0 (0.00%) 0 (0.00%) 0 (0.00%) Live Births 2,909 (97.10%) 1,773 (95.94%) 0.08 2,079 (94.72%) 1,333 (94.74%) 0.97 Stillbirth (Total) 72 (2.39%) 57 (3.08%) 0.13 59 (2.69%) 47 (3.35) 0.10 MSB 63 (2.09%) 49 (2.65%) 0.34 52 (2.37%) 42 (2.99%) 0.52 FSB 9 (0.30%) 8 (0.43%) 7 (0.32%) 5 (0.36%) Resuscitation bag and mask 57 (1.91%) 36 (1.95%) 0.96 18 (0.82%) 1 (0.07%) 0.06 APGAR (5 min) Low (0–3) 135 (4.50%) 87 (4.72%) 0.92 153 (6.97%) 70 (5.00%) 0.003* Intermediate (4–6) 124 (4.13%) 79 (4.28%) 96 (4.38%) 40 (2.86%) Normal (7–10) 2,739 (91.27%) 1,677 (90.94%) 1,944 (88.65%) 1,289 (92.14%) APGAR (10 min) Low (0–3) 109 (3.64%) 74 (4.02%) 0.60 136 (6.20%) 62 (4.43%) 0.02* Intermediate (4–6) 45 (1.50%) 19 (1.03%) 26 (1.19%) 9 (0.64%) Normal (7–10) 2,843 (94.83%) 1,749 (94.90%) 2,032 (92.62%) 1,328 (94.92%) Birth weight (mean, SD) 2.97 (0.74) 2.90 (0.75) 0.002* 2.94 (0.76) 2.90 (0.79) 0.16 Extremely low 87 (2.89%) 61 (3.30%) 0.05* 49 (2.24%) 45 (3.21%) 0.41 Very low 107 (3.55%) 68 (3.68%) 119 (5.44%) 77 (5.50%) Low 308 (10.23%) 226 (12.23%) 262 (11.97%) 169 (12.07%) Normal 2,390 (79.40%) 1,442 (78.03%) 1,680 (76.78%) 1,052 (75.14%) High 118 (3.92%) 51 (2.76%) 78 (3.56%) 57 (4.07%) Birth defects Yes 19 (0.63%) 14 (0.76%) 0.70 13 (0.60%) 7 (0.50%) 0.23 N/A 41 (1.37%) 17 (0.92%) 52 (2.38%) 22 (1.57%) Live birth to HIV-positive mother Yes - 1,422 (77.16%) - 555 (39.61%) <0.001* N/A - 12 (0.65%) - 45 (3.21%) Nevirapine administered Yes - 1,323 (71.86%) - 546 (38.97%) <0.001* N/A - 21 (1.14%) - 38 (2.71%) Daily Nevirapine administered Yes - 359 (19.53%) - 262 (18.70%) 0.52 N/A - 35 (1.90%) - 34 (2.43%) Antepartum Haemorrhage 46 (1.54%) 36 (1.95%) 0.50 29 (1.33%) 25 (1.79%) 0.54 Postpartum Haemorrhage 17 (0.57%) 10 (0.54%) 0.96 44 (2.01%) 26 (1.85%) 0.94 Preeclampsia 44 (1.47%) 18 (0.97) 0.30 67 (3.06%) 30 (2.14%) 0.25 Eclampsia 19 (0.64%) 11 (0.60%) 0.95 15 (0.68%) 1 (0.07%) 0.03* Sepsis 25 (0.84%) 31 (1.68%) 0.03* 174 (7.96%) 174 (12.52%) <0.001* Obstructed/Prolonged Labour 26 (0.87%) 9 (0.49%) 0.30 52 (2.38%) 19 (1.37%) 0.26 *p < 0.05; **p < 0.005; ***p < 0.00 considered statistically significant. Prior to the pandemic resuscitation was only required for a small number of HIV uninfected versus infected babies (1.91% vs 1.95); and decreased during the pandemic (0.82% vs 0.07%) in both groups, the 5- and 10-minute APGAR scores ranged between 7–10 for most babies born regardless of the the maternal HIV status or the period analysed).During the pandemic, a significant decline was noted for normal APGAR scores at 5min (n = 1,289 vs 1,944; p < 0.005) and 10min (n = 1,328 vs 2,032; p < 0.05), for babies born to HIV infected mothers versus uninfected mothers, respectively. Surprisingly, a higher percentage of babies were born from HIV uninfected mothers with APGAR scores in the low range (i.e., 5 min: 6.97% vs 5.00%; p < 0.005; 10 min: 6.20% vs 4.43%; p < 0.05) and intermediate ranges (5 min: 4.38% vs 2.86%; p < 0.005; 10 min: 1.19% vs 0.64%; p < 0.05) compared to HIV infected women. Prior to the pandemic, birth weight was lower (2.90 ± 0.75 vs 2.97 ± 0.74; p < 0.005) in babies born to HIV-infected mothers compared to uninfected mothers; and the number of live births was lower 1,422 (77.16%) compared to during the pandemic 555 (39.61%); p < 0.001. Of these births, a decline was noted amongst babies receiving Nevirapine postpartum 1,323 (71.86%) vs 546 (38.97%); p < 0.001 and those receivingdaily doses 359 (19.53%) vs 262 (18.70%); p < 0.001, prior to and during the pandemic. Noteworthy, the rate of eclampsia development was lower in HIV-infected pregnancies during the pandemic uninfected pregnancies (0.07% vs 0.68%; p < 0.05). During the pandemic, sepsis infection was higher in HIV-infected pregnancies compared to uninfected pregnancies (12.52% vs 7.96%; p < 0.001). Association between HIV and infant birth outcomes during the COVID – 19 pandemic Significant associations were observed between HIV status and birth outcomes during the COVID–19 pandemic (Table 3 ). Prior to the pandemic, HIV positive women had 1.23 times (OR: 1.23; 95% CI: 1.07, 1.41; p = 0.004) significantly higher risk of delivery at ≤ 37 weeks. In contrast this risk was reduced to 1.06 times (OR: 1.06; 95% CI: 0.91, 1.23; p = 0.47) likelihood during the pandemic, albeit non-significant. Additionally, HIV positive women were less likely to deliver at ≥ 37 weeks during the pre-COVID–19 (OR: 0.81; 95% CI: 0.71, 0.94 vs OR: 1.23;95%CI:1.07,1.41; p = 0.004) and COVID–19 (OR: 0.94; 95% CI: 0.81, 1.10 vs OR: 1.06; 95% CI: 0.91, 1.24; p = 0.47) periods in comparison to HIV-uninfected women. Despite non-significance, HIV positive women had 0.97 times (OR: 0.97; 95% CI: 0.84, 1.12; p = 0.70) lower risk of requiring emergency caesarean section (C/S) during the pandemic. However, the likelihood of elective C/S during this period amongt HIV positive women was high(OR: 1.21; 95% CI: 0.97, 1.52; p = 0.09). Moreover, a higher risk of stillbirth was associated with positive HIV status, with a 1.28 (OR: 1.28; 95% CI: 0.93, 1.76; p = 0.13) and 1.37 (OR: 1.37; 95% CI: 0.94, 1.99; p = 0.10) times likelihood of stillbirth during the pre-COVID-19 periods, respectively. In contrast, HIV-uninfected women had a lower risk of stillbirth prior to (OR: 0.78; 95% CI: 0.57, 1.08; p = 0.13) and during (OR: 0.73; 95% CI: 0.50, 1.06; p = 0.10) the pandemic. Table 3 Associations between maternal age, gravidity and parity on complications of labour and birth outcomes HIV negative HIV positive Pre-COVID-19 (n = 3011) COVID (n = 2196) Pre-COVID-19 (n = 1849) COVID (n = 1407) OR (95% CI) p-value OR (95% CI) p-value OR (95% CI) p-value OR (95% CI) p-value Gestational age at birth : < 37 weeks 1.06 (0.91, 1.24) 0.47 0.94 (0.81, 1.10) 0.47 1.23 (1.07, 1.41) 0.004** 1.06 (0.91, 1.23) 0.47 > 37 weeks 1.23 (1.07, 1.41) 0.004** 1.06 (0.91, 1.24) 0.47 0.81 (0.71, 0.94) 0.004** 0.94 (0.81, 1.10) 0.47 Caesarean section Emergency 1.01 (0.90, 1.14) 0.87 1.02 (0.89, 1.19) 0.70 0.99 (0.88, 1.11) 0.84 0.97 (0.84, 1.12) 0.70 Elective 1.05 (0.82, 1.35) 0.68 0.82 (0.66, 0.13) 0.09 0.95 (0.74, 1.21) 0.68 1.21 (0.97, 1.52) 0.09 Stillbirth 0.78 (0.57, 1.08) 0.13 0.73 (0.50, 1.06) 0.10 1.28 (0.93, 1.76) 0.13 1.37 (0.94, 1.99) 0.10 Birth weight Extremely low - 0.70 (0.43, 1.16) 0.17 - 1.42 (0.86, 2.33) 0.17 Very low 1.10 (0.71, 1.72) 0.67 - 0.91 (0.58, 1.42) 0.67 - Low 0.96 (0.66, 1.38) 0.81 1.00 (0.71, 1.41) 0.99 1.04 (0.72, 1.51) 0.81 1.00 (0.71, 1.41) 0.99 Normal 1.16 (0.83, 1.62) 0.38 1.03 (0.77, 1.39) 0.83 0.86 (0.62, 1.20) 0.37 0.97 (0.72, 1.30) 0.83 High 1.62 (1.02, 2.58) 0.04* 0.87 (0.56, 1.37) 0.56 0.62 (0.39, 0.98) 0.04* 1.14 (0.73, 1.79) 0.56 APGAR 5min Low 0.52 (0.05, 5.05) 0.57 0.91 (0.57, 1.45) 0.69 1.93 (0.20, 18.89) 0.57 1.10 (0.69, 1.75) 0.69 Intermediate 0.52 (0.05, 5.12) 0.58 - 1.91 (0.20, 18.70) 0.58 - Normal 0.54 (0.06, 5.23) 0.60 0.63 (0.43, 0.92) 0.02* 1.83 (0.19, 17.67) 0.60 1.59 (1.09, 2.31) 0.02* APGAR 10min Low 0.62 (0.34, 1.15) 0.13 0.76 (0.34, 1.72) 0.51 1.61 (0.87, 2.97) 0.13 1.32 (0.58, 2.98) 0.51 Intermediate - - - - Normal 0.69 (0.40, 1.18) 0.17 0.53 (0.25, 1.13) 0.10 1.46 (0.85, 2.50) 0.17 1.89 (0.88, 4.04) 0.10 *p < 0.05; **p < 0.005; ***p < 0.00 considered statistically significant. Babies born to HIV–positive women were 0.97 times (OR: 0.97; 95% CI: 0.72, 0.30; p = 0.83) less likely to be within the normal birth weight range during the pandemic in comparison to HIV–negative women (OR: 1.03; 95% CI: 0.77, 1.39; p = 0.83). During the pandemic, the risk of delivering extremely LBW babies is almost doubled in HIV–positive pregnant women (OR: 1.42; 95% CI: 0.86, 2.33; p = 0.17) compared to HIV– negative women (OR: 0.70; 95% CI: 0.43, 1.16; p = 0.17). Interestingly, during the pandemic, HIV–positive women were 1.14 times (OR: 1.14; 95% CI: 0.73, 1.79; p = 0.56) more likely to deliver a baby of high birth weight, while this risk was 0.87 times (OR: 0.87; 95% CI: 0.56, 1.37; p = 0.56) lower in HIV–negative women. During the pandemic, babies born to HIV positive mothers were more likely to produce low 5 minute APGAR scores in comparison to HIV-uninfected women during the pre-COVID-19 (OR: 1.93; 95% CI: 0.20, 18.89 vs OR: 0.52; 95% CI: 0.05, 5.05; p = 0.57) and lockdown (OR: 1.10; 95% CI: 0.69, 1.75 vs OR: 0.91; 95% CI: 0.57, 1.45; p = 0.69) periods. However, it is interesting to note that during the pandemic, HIV–positive pregnant women also demonstrated a significant 1.5 fold increase (OR: 1.59; 95% CI: 1.09, 2.31; p = 0.02) in the odds of delivering babies that had a normal 5 minute APGAR score in comparison to HIV–negative women, where the odds of this was significantly reduced (OR: 0.63; 95% CI: 0.43, 0.92; p = 0.02). A similar trend was followed with 10 minute APGAR scores, where babies born to HIV–positive women had a higher likelihood of low APGAR scores compared to those of HIV–negative mothers during the pre-COVID–19 (OR: 1.61; 95% CI: 0.87, 2.97 vs OR: 0.62; 95% CI: 0.34, 1.15; p = 0.13) and the COVID–19 (OR: 1.32; 95% CI: 0.58, 2.98 vs OR: 0.76; 95% CI: 0.34, 1.72; p = 0.51) periods. Of interest, normal 10 minute APGAR scores were also more likely to be associated with babies born from HIV–positive in comparison to HIV–negative women during the pre-COVID–19 (OR: 1.46; 95% CI: 0.85, 2.50 vs OR: 0.69; 95% CI: 0.40, 1.18; p = 0.17) and COVID–19 (OR: 1.89; 95% CI: 0.88, 4.04 vs OR: 0.53; 95% CI: 0.25, 1.13; p = 0.10) periods. Discussion Our findings demonstrate a significant difference in maternal demographic and clinical characteristics among HIV-infected pregnant women accessing hospital based antenatal care prior to compared to during the COVID-19 pandemic, on a decrease in overall hospital attendance was noted during the pandemic, aligning with global reports of reduced maternal health service utilization due to movement restrictions, fear of contracting SARS-CoV-2, and resource reallocation within health systems [ 27 , 28 ]. Albeit this reduction was higher among HIV-infected women, confirming the adverse impact of the pandemic’s on access to HIV care and antenatal services, as previously reported in sub-Saharan Africa [ 29 ]. Our findings also highlight a statistically significant difference for maternal age, gravidity, and parity between the 2 study periods (p < 0.001). Most of HIV-infected women were aged 19–35 years and were predominantly multigravida and multiparous, consistent with previous reports that women of reproductive age with extensive obstetric histories, are at an elevated risk for HIV acquisition and transmission [ 30 – 32 ]. Noteworthy, HIV-infection is associated with a higher cumulative childbirth and sexual exposure, whereas antenatal care booking patterns remained suboptimal for HIV-infected women, with persistent late bookings delaying the timely initiation of prevention of mother-to-child transmission interventions, thus corroborating previous reports [ 33 ]. Alarmingly, most women did not meet the WHO recommended minimum of eight ANC visits, a deficit that worsened during the pandemic, reflecting ongoing challenges in maternal health service delivery and utilization [ 34 , 35 ]. Regarding the ART regimen data, a slight increase was observed in dual fixed-dose combination (FDC) ART usage in contrast to a decrease in triple ART regimens among HIV-infected women. This discrepancy may be due to the implementation of a more simplified treatment protocol, or public health modifications, and/or revised guidelines endorsing dual therapy, all of which may have focused on ensuring continuity of ART while minimizing COVID-19 exposure risk [ 36 ]. Despite these disruptions, there was a notable reduction in the proportion of HIV-infected pregnant women with elevated viral loads (> 1,000 copies/mL and > 10,000 copies/mL), which may be attributed to effective maintenance of virologic suppression among those retained in care. Birth outcomes showed that majority of women delivered at term (≥ 37 weeks’ gestation) in both study intervals. Our findings corroborate Molina et al (2022), who reported a stabilisation in the rate of preterm births before and during covid-19 [ 37 ]. We also observed a reduction in the number of preterm births during the pandemic, which aligns with previous reports [ 38 , 39 ], however this may be attributed to reduced working hours, decreased physical and/or emotional stress associated with employment, a decrease in infections due to improved hygiene and reduced social interactions, lower rates of smoking and substance abuse, the presence of familial support at home, increased time for physical exercise, reduced exposure to environmental pollutants, and less vehicular travel, resulting in decreased stress and fewer accident [ 38 , 39 ]. Additionally, we demonstrate significantly shorter duration of active labour in women with HIV compared towomen without, both before and after the COVID-19 pandemic. Our findings corroborate previous reports, which indicate that prolonged labour increases the risk of mother-to-child HIV transmission, HIV infected women typically have shorter active labour periods than uninfected women [ 40 – 42 ]. Current clinical management plans strive to reduce the duration of labour as a means to reduce foetal exposure to the virus through maternal blood and cervical secretions [ 40 ]. More recently, an association between HIV infection and changes in myometrial function and/or hyperinflammatory activity was reported, suggestive of an ameliorative effect on labour progression[ 43 ]. Overall, data regarding modes of delivery failed to demonstrate any significance between the 2 study intervals; however, caesarean section rates increased during the pandemic for both HIV-infected and uninfected women. The low rates of vacuum and forceps deliveries are consistent with longstanding limitations in many African settings [ 44 ], which was further decreased during the pandemic perhaps due to concerns about prolonged close contact with potentially infectious patients and staff shortages. During the pandemic, we observed a slight decrease in breech presentations, labour inductions, and miscarriages among HIV-infected women, and surprisingly no maternal deaths in either group across both study intervals. These findings suggests that the local healthcare systems strived to maintain high standards of maternal care during and after the pandemic, irrespective of HIV status. Both live births and stillbirths decreased during the COVID-19 pandemic, which is inconsistent with that reported by Galis and coworkers, who demonstrated an increase in the stillbirth rate during COVID-19 pandemic (RR: 1.53, 95% CI, 1.05–2.23) [ 45 ]. The data from prior to the pandemic, highlights normal APGAR scores between five and ten minutes after birth as well as a reduction in newborn resuscitation rates regardless of the mother's HIV status. In contrast, during the pandemic, fewer HIV-infected women had babies with normal APGAR scores, while HIV-uninfected women had comparatively lower or intermediate scores. Birth weight was also significantly lower among infants born to HIV-infected mothers before the pandemic, a trend widely reported in the literature and attributed to HIV-associated placental dysfunction, chronic inflammation, and ART exposure [ 8 , 46 , 47 ]. During the pandemic, obstetric complications like haemorrhage, preeclampsia, and obstructed labour were less common in women infected with HIV than those not infected. However, our findings differs from previous reports that highlight higher complication rates in HIV-infected pregnancies [ 44 , 48 – 50 ], indicative of HIV-infected women practicingdifferent health-seeking practices, visiting facilities, or changes in risk profiles [ 51 ]. During the pandemic, we also demonstrated a higher incidence of sepsis among women with HIV. Studies indicate that HIV infection can induce immunosuppression, subsequently resulting in a broader spectrum of aetiologies that can promote the onset of sepsis [ 52 , 53 ]. Prior to the pandemic, we report a higher of preterm delivery (≤ 37 weeks) among HIV-infected women, which concur with Naidoo and coworkers, who reported that HIV-infected mothers were significantly more ~ 4 fold likelyto have preterm deliveries than their HIV-uninfected counterparts [ 54 ]. Additionally, reports confirm a higher risk of Preterm Birth < 37 weeks among HIV infected women than those without (32% vs. 23%, RR = 1.43, 95% Cl: 1.07–1.91) [ 55 ]. However, our bivariate analysis showed no correlation between maternal HIV statu and the incidence of preterm delivery during the pandemic. Albeit previous studies confirmed that HIV-infected women, especially those with uncontrolled infection or without ART, had a higher risk of preterm birth due to immune activation and systemic inflammation [ 56 , 57 ]. Our findings concur with Mugo and colleagues, who suggests that with effective ART, HIV infection itself may not significantly increase preterm delivery risk [ 58 ]. During the pandemic, the disruptions in healthcare access and consequent elevations in stress levels may have influenced the risk of preterm birth regardless of the HIV status. Further research is needed to fully understand the complex interplay between HIV, ART, and preterm birth, particularly the specific mechanisms that might lead to an increased risk in some cases. HIV-infected women also exhibited a non-significant reduction in risk for emergency caesarean section During the pandemic, there was a notable trend towards increased elective caesarean deliveries amongst HIV infected women. Elective caesareans are the preferred delivery options taken by HIV-infected women to reduce vertical transmission risk [ 59 ], particularly when viral suppression is suboptimal [ 60 , 61 ]. The shift observed during the pandemic may reflect a change in hospital policies and a preference for planned interventions to limit both maternal and staff exposure to viral exposure. Our findings also highlight an association between HIV infection and lower birth weight before the pandemic and higher birth weight during the pandemic, albeit non-significant. The analysis showed that, HIV-infected women were more likely to deliver infants with low 5 and 10 minute APGAR scores during both periods, there was a significant increase in the odds of normal APGAR scores among infants born to HIV-infected mothers during the pandemic, compared to HIV-uninfected women. Conclusion This study highlights how the COVID-19 pandemic caused major disruptions to HIV services and prenatal care for pregnant women, particularly those with HIV, which resulted in fewer hospital visits and difficulties in sustaining the best possible care. Modifying management plans such as updated ART regimes helped maintain viral suppression among women with HIV despite these interruptions. Pregnancy outcomes were still influenced by maternal HIV status; before the pandemic, HIV-positive women had different labour patterns and obstetric risks. However, during the pandemic, some disparities, like the risk of preterm birth, decreased, perhaps because of multifactorial factors like improved HIV management and changes in healthcare access. Notably, constant maternal mortality and some improved newborn indicators suggested that overall maternal care quality was durable during the pandemic, even though poor birth outcomes were still higher among women with HIV. These results demonstrate how crucial it is to continue providing specialised HIV and maternity care during medical emergencies to protect vulnerable groups. Declarations Acknowledgements The authors thank the Labour Ward staff at the local tertiary affiliated hospital for their support in accessing the data. Contribution to authorship NG and JM conceptualised the study. SR performed the analysis. SR and ZM drafted the manuscript. All authors commented on and edited the manuscript Funding This study was funded by the National Research Foundation of South Africa (grant number SRUG2205056757). Data availability statement The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available because of privacy or ethical restrictions Conflict of interest: No potential conflict of interest was reported by the authors . Consent to participate Informed consent was obtained from all individual participants included in the study . References UNAIDS. Global AIDS Update 2024 https://www.unaids.org/en/resources/fact-sheet . 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Cite Share Download PDF Status: Published Journal Publication published 19 Feb, 2026 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted Editorial decision: Revision requested 27 Nov, 2025 Reviews received at journal 09 Oct, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviews received at journal 23 Sep, 2025 Reviewers agreed at journal 23 Sep, 2025 Reviewers invited by journal 22 Sep, 2025 Editor assigned by journal 05 Sep, 2025 Submission checks completed at journal 02 Sep, 2025 First submitted to journal 01 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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15:10:48\",\"extension\":\"html\",\"order_by\":5,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":193405,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"earlyproof.html\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7508995/v1/a7c6494cd8c791dd694c1229.html\"},{\"id\":103252183,\"identity\":\"9a876cbb-cbbd-4104-a396-b439987b5c87\",\"added_by\":\"auto\",\"created_at\":\"2026-02-23 16:13:18\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1351187,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7508995/v1/91fc00b8-28df-467c-90d7-850ed36251b1.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Impact of Maternal HIV Infection on Pregnancy and Labour Complication and Perinatal Health Outcomes: A South African Retrospective Study\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eGlobally, 40.8\\u0026nbsp;million people were reported to be living with human immunodeficiency virus (HIV) in 2024, of which [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e] 53% were females, and of reproductive age [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. HIV infection is a major contributor to maternal mortality and morbidity, especially in low\\u0026ndash; and middle\\u0026ndash;income countries (LMIC), particularly Sub-Saharan Africa [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e] and southern Asia [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. Pregnant women living with HIV have 2\\u0026ndash;10 times increased risk of death during pregnancy and the postpartum period compared with uninfected pregnant women [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. South Africa (SA) remains the epicentre of HIV infection, with approximately 8\\u0026nbsp;million people living with HIV (PLHIV) [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. Of note, in 2020 it was reported that one in three pregnant women receiving antenatal care in SA is HIV infected [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e].This infectivity rate accounts for 27.5% of most early-maternal deaths in SA, second to hypertensive disorders of pregnancy (HDPs) [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eMaternal HIV infection is also associated with increased pregnancy complications and higher risk of adverse perinatal outcomes including low birth weight (LBW:\\u0026lt; 2500g) and perinatal and early neonatal mortality [\\u003cspan additionalcitationids=\\\"CR9\\\" citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. The effect of antiretroviral therapy (ART) on this association remains unclear [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e].It is well established that ART improves the overall health and quality of life for PLHIV and reduces the rate of mother\\u0026ndash;to\\u0026ndash;child transmission [\\u003cspan additionalcitationids=\\\"CR13\\\" citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. However, its use during pregnancy may be associated with preterm birth, stillbirth, and fetal growth restriction, depending on ART regimen and the timing of initiation [\\u003cspan additionalcitationids=\\\"CR16\\\" citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eDespite the immediate rollout of the World Health Organisation (WHO) Option B\\u0026thinsp;+\\u0026thinsp;strategic initiation of lifelong ART to all South African pregnant and breastfeeding women living with HIV, regardless of HIV staging or CD4\\u003csup\\u003e+\\u003c/sup\\u003ecount [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e] HIV remains the primary cause of morbidity and mortality for children under 5 years [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]. In SA, the maternal and perinatal mortality and morbidity burden was further compounded by the COVID\\u0026ndash;19 pandemic [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. Additionally, the nationwide lockdown implemented between March 2020 and July 2022 due to rapid community transmission of SARS CoV\\u0026ndash;2, resulted in disruptions in daily transportationreduced community services and healthcare access [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. This subsequently created difficulties in managing chronic diseases such as HIV, diabetes and hypertension; negatively impacting maternal and perinatal health, particularly those affected with HIV[\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eTo our knowledge, limited South African data exists regarding the impact of maternal HIV on birth complications and perinatal birth outcomes especially during the COVID-19 pandemic. In view of this, we evaluated the effect of maternal HIV infection on pregnancy complications and perinatal health outcomes using archived data from a local tertiary hospital in KwaZulu-Natal.\\u003c/p\\u003e\"},{\"header\":\"Materials and methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eEthical appoval\\u003c/h2\\u003e\\u003cp\\u003eThis study was approved by the Institutional Research Ethics Committee, Durban University of Technology (IREC 054/22). The was no direct patient involvement during data collection as only archived data records were used.\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eStudy details\\u003c/h3\\u003e\\n\\u003cp\\u003eThis retrospective study was a primary analysis of birth registry data extracted from a local tertiary affiliated hospital in KwaZulu-Natal, South Africa. Only data between 1 March 2019 and 31 December 2020 were included irrespective of maternal health status or perinatal birth outcomes. All recorded data were manually extracted and thereafter coded for statistical analysis. Most outcomes and covariates were directly extracted from structured data fields within the birth registry record. Data was compared based on time periods categorized as pre\\u003cb\\u003e-\\u003c/b\\u003eCOVID\\u0026ndash;19 (March 2019 \\u0026ndash; February 2020) and during the COVID\\u0026ndash;19 (March 2020 \\u0026ndash; Dec 2020) pandemic. All data were sub-categorised according to HIV status (HIV\\u0026ndash;negative and HIV\\u0026ndash;positive); age (\\u0026lt;\\u0026thinsp;18, 19\\u0026ndash; 35 and \\u0026gt;\\u0026thinsp;35 years old); gravidity (primigravida or multigravida); parity (nulliparous, primiparous and multiparous); and gestational age (at birth as \\u0026lt;\\u0026thinsp;37 weeks and \\u0026ge;\\u0026thinsp;37 weeks), respectively. Antenatal care (ANC) bookings were classified as \\u0026lt;\\u0026thinsp;20 weeks and \\u0026gt;\\u0026thinsp;20 weeks; and number of ANC visits as \\u0026lt;\\u0026thinsp;8 and \\u0026ge;\\u0026thinsp;8, respectively. ART treatment was categorised as either untreated, fixed-dose combination (FDC) or triple ART treatment, whereas viral load as LTDL (undetectable), \\u0026le;\\u0026thinsp;1000 (suppressed), \\u0026gt;\\u0026thinsp;1000 (unsuppressed) and \\u0026gt;\\u0026thinsp;10 000 copies, respectively.\\u003c/p\\u003e\\u003cp\\u003eMode of delivery was categorised as vaginal birth (normal vertex) and caesarean section (CS), with CS further sub-categorized as emergency CS and elective CS, respectively. Regarding labour, the followingcategories were analysed, viz., follows, vacuum utilization, forceps utilization, breech presentation, miscarriage, induction of labour, antepartum haemorrhage, postpartum haemorrhage, preeclampsia (PE), eclampsia, sepsis and obstructed and/or prolonged labour. Perinatal health outcomes were categorised as live and stillbirths, with stillbirths sub-categorised as macerated stillbirth (MSB) and fresh stillbirth (FSB). The APGAR (5 min) and (10 min) scores were categorised as low (0\\u0026ndash;3), intermediate (4\\u0026ndash;6) and normal (7\\u0026ndash;10). The variables \\u0026ldquo;resuscitate bag and mask utilization\\u0026rdquo;, \\u0026ldquo;neonatal birth defects\\u0026rdquo;,\\u0026ldquo;birth defects defined\\u0026rdquo;, Nevirapine (NVP) and daily NVP administration were categorised as \\u0026ldquo;yes\\u0026rdquo;, \\u0026ldquo;no\\u0026rdquo; and \\u0026ldquo;non-applicable (N/A)\\u0026rdquo; respectively.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eStatistical Analysis\\u003c/h2\\u003e\\u003cp\\u003eAll data was analysed using STATA (version 12, STATACORP) and GraphPad Prism 5. The data was assessed for normality using the skewness and kurtosis normality test. All continuous data are summarized as means and standard deviation. The unpaired t-test was used to compare the means for maternal age, gravidity, parity and gestational age between the pre-COVID\\u0026ndash;19 and COVID\\u0026ndash;19 pandemic time periods. Categorical data are presented as frequency and percentages, and the Pearson\\u0026rsquo;s chi-squared test was used to determine bivariate associations between demographic and clinical variables stratified by time (i.e., pre-COVID\\u0026ndash;19 and during the pandemic). Binary logistic regression was used to determine the relationship between HIV status and gestational age at birth, caesarean section delivery, stillbirth, birth weight and 5- and 10-minute APGAR scores during both time periods. A 95% confidence interval (CI) was used and \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 was considered statistically significant.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eMaternal characteristics\\u003c/h2\\u003e\\n \\u003cp\\u003eThe demographic and clinical profiles of the study population are shown in Table \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. Of the 8,463 records analysed, 4,861 pregnant women attended the hospital prior to the pandemic, versus 3,603 during the pandemic and/or national lockdown. Of those who attended during the pandemic (pre-COVID), 1,849 were HIV-infected; this number declined (n\\u0026thinsp;=\\u0026thinsp;1,407) during the pandemic.Noteworthy, significant statistical differences were observed for maternal age, gravidit\\u003cstrong\\u003ey\\u003c/strong\\u003e and parity categories (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) between the two periods analysed. Amongst the HIV-infected women who accessed the hospital pre- and during COVID-19, the majority were aged between 19\\u0026ndash;35 years (77.09% \\u003cem\\u003evs\\u003c/em\\u003e 74.96%), multigravida (85.97% \\u003cem\\u003evs\\u003c/em\\u003e 84.87%) and multiparous (55.59% \\u003cem\\u003evs\\u003c/em\\u003e 50.97%). A similar trend was observed amongst the HIV-uninfected women for age and gravidity, however, for parity, nulliparous (39.38% \\u003cem\\u003evs\\u003c/em\\u003e 43.45%) was dominant in both time periods. A noticeable decline was noted in the number of ANC bookings made prior to twenty weeks of gestation by HIV positive women versus HIV uninfected women during both time periods (pre-COVID-19 1,415 \\u003cem\\u003evs\\u003c/em\\u003e 885; pandemic 1,083 \\u003cem\\u003evs\\u003c/em\\u003e 690), albeit non-significant. Notably, the average number of ANC visits were less than eight regardless of HIV status or the time periods analysed. Only 330 (11.21%) HIV uninfected women attended more than eight ANC visits before the pandemic. For HIV\\u0026ndash;infected women, 245 (13.56%) accessed more than eight ANC visits and this access decreased during the pandemic (n\\u0026thinsp;=\\u0026thinsp;144; 10.79%).\\u003c/p\\u003e\\n \\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003ctable id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eDemographic and clinical profiles stratified by study period (pre-COVID-19 and during COVID-19) and HIV status\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth colspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePre-COVID\\u0026ndash;19 (n\\u0026thinsp;=\\u0026thinsp;4853)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth colspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCOVID\\u0026ndash;19 (n\\u0026thinsp;=\\u0026thinsp;3606)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHIV Status\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep\\u003c/strong\\u003e\\u0026ndash;\\u003cstrong\\u003evalue\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHIV Status\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep\\u003c/strong\\u003e\\u0026ndash;\\u003cstrong\\u003evalue\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNegative (n\\u0026thinsp;=\\u0026thinsp;2984)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePositive\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(n\\u0026thinsp;=\\u0026thinsp;1842)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNegative\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(n\\u0026thinsp;=\\u0026thinsp;2188)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePositive\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(n\\u0026thinsp;=\\u0026thinsp;1142)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAge\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026lt;\\u0026thinsp;18\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e454 (15.21%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e50 (2.71%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e348 (15.90%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e88 (6.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e19\\u0026ndash;35\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2,315 (77.58%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,420 (77.09%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,638 (74.86%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,052 (74.96%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026gt;\\u0026thinsp;35\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e215 (7.21%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e372 (20.20%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e202 (9.23%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.63 (18.75%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eGravidity\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003ePrimigravida\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,203 (40.06%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e259 (14.03%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e922 (42.43%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e211 (15.13%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eMultigravida\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,800 (59.94%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,587 (85.97%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,251 (57.57%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,184 (84.87%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eParity\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eNulliparous\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,174 (39.38%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e264 (14.33%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e942 (43.45%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e207 (14.88%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003ePrimiparous\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e904 (30.33%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e554 (30.08%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e630 (29.06%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e475 (34.15%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eMultiparous\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e903 (30.29%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,024 (55.59%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e596 (27.49%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e709 (50.97%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eANC booking\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026lt;\\u0026thinsp;20 weeks\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,415 (48.24%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e885 (48.76%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.31\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,083 (50.61%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e690 (50.07%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.57\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026gt;\\u0026thinsp;20 weeks\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,518 (51.76%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e930 (51.24%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,057 (49.39%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e688 (49.93%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo of ANC visits\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026lt;\\u0026thinsp;8\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2,613 (88.79%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,562 (86.44%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.05*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,904 (88.97%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,191 (89.21%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.82\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026ge;8\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e330 (11.21%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e245 (13.56%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e380 (10.92%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e144 (10.79%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOn ART\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eUntreated\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e56 (3.05%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e65 (4.62%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eFDC\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e102 (5.55%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e133 (9.45%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eTriple\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,679 (91.40%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,209 (85.93%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eViral load\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eUndetectable\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e490 (55.12%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"4\\\" align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e221 (55.25%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"4\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.01*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026le;\\u0026thinsp;1000 copies\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e288 (32.40%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e150 (37.50%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026gt;\\u0026thinsp;1000 copies\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e60 (6.75%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10 (2.50%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026gt;\\u0026thinsp;10 000 copies\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e51 (5.74%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e19 (4.75%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eGestational age at birth\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026lt;\\u0026thinsp;37 weeks\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e601 (20.07%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e437 (23.70%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.04*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e537 (24.53%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e360 (25.59%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.66\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026ge;\\u0026thinsp;37 weeks\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2,392 (79.93%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,407 (76.30%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,652 (75.47%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1,047 (74.41%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003c/div\\u003e\\n \\u003cp\\u003eA significant difference was noted in the number of HIV\\u0026ndash;positive women who were on ART during both time periods (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Of note, most women were on either dual (FDC) (5.55%) or triple (91.40%) ART prior to the pandemic, whereas during the pandemic, only 133 (9.45%) were managed on FDC and 1209 (85.93%) on triple ART. Regrettably, a small percentage of HIV\\u0026ndash;positive women were not managed on any form of ART prior (3.05%) to or during (4.62%) the pandemic. Noteworthy, viral loads of \\u0026gt;\\u0026thinsp;1000 copies in this cohort was lower (6.75%) during the pandemic compared to prior (2.50%). Likewise, 5.74% of this cohort demonstrated\\u0026thinsp;\\u0026gt;\\u0026thinsp;10 000 copies during the pandemic versus 4.75%. Most deliveries occurredat\\u0026thinsp;\\u0026ge;\\u0026thinsp;37 weeks regardless of the time periods analysed. However prior to the pandemic, pre-term (\\u0026lt;\\u0026thinsp;37 weeks) deliveries were higher recorded amongst HIV uninfected (n\\u0026thinsp;=\\u0026thinsp;601) versus infected women (n\\u0026thinsp;=\\u0026thinsp;437; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). A similar trend was noted during the pandemic (537 uninfected \\u003cem\\u003evs\\u003c/em\\u003e 360 HIV infected).\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eLabour and birth outcomes\\u003c/h2\\u003e\\n \\u003cp\\u003eThe labour and birth outcomes for the study population are shown in Table\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e. The duration of active labour was shorter amongst the HIV infected versus the uninfected women prior to (8.11\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.64 \\u003cem\\u003evs\\u003c/em\\u003e 9.12\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.51; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) and during (8.57\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.28 \\u003cem\\u003evs\\u003c/em\\u003e 9.28\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.63; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.005) the pandemic. DDuring the pandemic, lower rates of normal vertex (47.97% \\u003cem\\u003evs\\u003c/em\\u003e 51.43%) and emergency CS (40.51% \\u003cem\\u003evs\\u003c/em\\u003e 42.40%) deliveries was observed in HIV infected women versus pre-COVID-19. As expected, elective CS deliveries increased during the pandemic in both HIV-infected (6.17% \\u003cem\\u003evs\\u003c/em\\u003e 11.51%) and uninfected (6.44% \\u003cem\\u003evs\\u003c/em\\u003e 9.56%) women compared to pre-COVID. Notably, low rates were noted forvacuum utilization during both time periods, with a slight decrease in HIV infected vs HIV-uninfected women (0.07% \\u003cem\\u003evs\\u003c/em\\u003e 0.18) during the pandemic. The use of forceps in supporting the delivery was higher in HIV uninfected versus HIV-infected women during the pandemic (1.15% vs 0.07%; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.001). During the pandemic, a reduction was observed in breach presentation (0.08% \\u003cem\\u003evs\\u003c/em\\u003e 0.68%), induction of labour (1.71% \\u003cem\\u003evs\\u003c/em\\u003e 3.69%) and miscarriage (0.22% \\u003cem\\u003evs\\u003c/em\\u003e 0.33%) in the HIV infected women compared to prior. Fortunately, no maternal deaths were recorded during both time periods. The number of live births was decreased in both HIV-infected (1,773 \\u003cem\\u003evs\\u003c/em\\u003e 1,333) and uninfected (2,909 \\u003cem\\u003evs\\u003c/em\\u003e 2,079) women during both time periods analysed. Prior to the pandemic, similar reductions were noted for stillbirths in both HIV-infected (n\\u0026thinsp;=\\u0026thinsp;57 \\u003cem\\u003evs\\u003c/em\\u003e 47) and uninfected (n\\u0026thinsp;=\\u0026thinsp;72 \\u003cem\\u003evs\\u003c/em\\u003e 59) women compared to during the pandemic.\\u003c/p\\u003e\\n \\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003ctable id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eLabour and birth outcomes of the study population stratified by study period (pre-COVID-19 and during COVID-19) and HIV status\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLabour and birth outcomes\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"3\\\" style=\\\"width: 288px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePre-COVID\\u0026ndash;19 (n=4853)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"3\\\" style=\\\"width: 288px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCOVID\\u0026ndash;19 (n=3606)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 224px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHIV Status\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep\\u003c/strong\\u003e\\u0026ndash;\\u003cstrong\\u003evalue\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 225px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHIV Status\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026ndash;\\u003c/strong\\u003e\\u003cstrong\\u003evalue\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNegative\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(n=2984)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePositive (n=1842)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNegative\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(n=2188)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePositive\\u003cbr\\u003e\\u0026nbsp;(n=1142)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eDuration of active labour (mean, SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e9.12 (4.51)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e8.11 (4.64)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.001*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e9.28 (4.63)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e8.57 (4.28)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.004*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eMode of birth\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n 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\\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eForceps utilization\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e10 (0.34%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e7 (0.39%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.94\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e25 (1.15%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1 (0.07%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.001*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eBreech presentation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e13 (0.45%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e12 (0.68%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.56\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e2 (0.09%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1 (0.08%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.99\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eInduction of Labour\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e115 (3.84%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e68 (3.69%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.88\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e45 (2.06%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e24 (1.71%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eMiscarriage\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e6 (0.21%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e6 (0.33%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.68\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e2 (0.09%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e3 (0.22%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eMaternal Death\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e0 (0.00%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e0 (0.00%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e0 (0.00%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e0 (0.00%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eLive Births\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e2,909 (97.10%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1,773 (95.94%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.08\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e2,079 (94.72%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1,333 (94.74%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.97\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eStillbirth (Total)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e72 (2.39%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e57 (3.08%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e59 (2.69%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e47 (3.35)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eMSB\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e63 (2.09%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e49 (2.65%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.34\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e52 (2.37%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e42 (2.99%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eFSB\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e9 (0.30%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e8 (0.43%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e7 (0.32%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e5 (0.36%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eResuscitation bag and mask\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e57 (1.91%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e36 (1.95%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.96\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e18 (0.82%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1 (0.07%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.06\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eAPGAR (5 min)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eLow (0\\u0026ndash;3)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e135 (4.50%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e87 (4.72%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"3\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.92\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e153 (6.97%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e70 (5.00%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"3\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.003*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eIntermediate (4\\u0026ndash;6)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e124 (4.13%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e79 (4.28%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e96 (4.38%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e40 (2.86%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eNormal (7\\u0026ndash;10)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e2,739 (91.27%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1,677 (90.94%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1,944 (88.65%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1,289 (92.14%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eAPGAR (10 min)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eLow (0\\u0026ndash;3)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e109 (3.64%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e74 (4.02%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"3\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.60\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e136 (6.20%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e62 (4.43%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"3\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.02*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eIntermediate (4\\u0026ndash;6)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e45 (1.50%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e19 (1.03%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e26 (1.19%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e9 (0.64%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eNormal (7\\u0026ndash;10)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e2,843 (94.83%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1,749 (94.90%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e2,032 (92.62%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1,328 (94.92%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eBirth weight (mean, SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e2.97 (0.74)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e2.90 (0.75)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.002*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e2.94 (0.76)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e2.90 (0.79)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eExtremely low\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e87 (2.89%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e61 (3.30%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"5\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.05*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e49 (2.24%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e45 (3.21%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"5\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eVery low\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e107 (3.55%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e68 (3.68%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e119 (5.44%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e77 (5.50%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eLow\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e308 (10.23%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e226 (12.23%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e262 (11.97%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e169 (12.07%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eNormal\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e2,390 (79.40%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1,442 (78.03%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1,680 (76.78%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1,052 (75.14%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eHigh\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e118 (3.92%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e51 (2.76%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e78 (3.56%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e57 (4.07%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eBirth defects\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eYes\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e19 (0.63%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e14 (0.76%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.70\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e13 (0.60%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e7 (0.50%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.23\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eN/A\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e41 (1.37%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e17 (0.92%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e52 (2.38%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e22 (1.57%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eLive birth to HIV-positive mother\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eYes\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1,422 (77.16%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 63px;\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e555 (39.61%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.001*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eN/A\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e12 (0.65%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e45 (3.21%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eNevirapine administered\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eYes\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1,323 (71.86%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 63px;\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e546 (38.97%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.001*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eN/A\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e21 (1.14%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e38 (2.71%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eDaily Nevirapine administered\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eYes\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e359 (19.53%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 63px;\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e262 (18.70%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eN/A\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e35 (1.90%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e34 (2.43%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eAntepartum Haemorrhage\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e46 (1.54%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e36 (1.95%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e29 (1.33%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e25 (1.79%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.54\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003ePostpartum Haemorrhage\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e17 (0.57%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e10 (0.54%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.96\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e44 (2.01%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e26 (1.85%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.94\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003ePreeclampsia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e44 (1.47%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e18 (0.97)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.30\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e67 (3.06%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e30 (2.14%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.25\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eEclampsia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e19 (0.64%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e11 (0.60%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.95\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e15 (0.68%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1 (0.07%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.03*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eSepsis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e25 (0.84%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e31 (1.68%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.03*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e174 (7.96%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e174 (12.52%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.001*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 186px;\\\"\\u003e\\n \\u003cp\\u003eObstructed/Prolonged Labour\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e26 (0.87%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e9 (0.49%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.30\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e52 (2.38%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e19 (1.37%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003c/div\\u003e*p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05; **p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.005; ***p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.00 considered statistically significant.\\n\\u003c/div\\u003e\\n\\u003cp\\u003ePrior to the pandemic resuscitation was only required for a small number of HIV uninfected versus infected babies (1.91% \\u003cem\\u003evs\\u003c/em\\u003e 1.95); and decreased during the pandemic (0.82% \\u003cem\\u003evs\\u003c/em\\u003e 0.07%) in both groups, the 5- and 10-minute APGAR scores ranged between 7\\u0026ndash;10 for most babies born regardless of the the maternal HIV status or the period analysed).During the pandemic, a significant decline was noted for normal APGAR scores at 5min (n\\u0026thinsp;=\\u0026thinsp;1,289 \\u003cem\\u003evs\\u003c/em\\u003e 1,944; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.005) and 10min (n\\u0026thinsp;=\\u0026thinsp;1,328 \\u003cem\\u003evs\\u003c/em\\u003e 2,032; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05), for babies born to HIV infected mothers versus uninfected mothers, respectively. Surprisingly, a higher percentage of babies were born from HIV uninfected mothers with APGAR scores in the low range (i.e., 5 min: 6.97% \\u003cem\\u003evs\\u003c/em\\u003e 5.00%; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.005; 10 min: 6.20% \\u003cem\\u003evs\\u003c/em\\u003e 4.43%; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) and intermediate ranges (5 min: 4.38% \\u003cem\\u003evs\\u003c/em\\u003e 2.86%; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.005; 10 min: 1.19% \\u003cem\\u003evs\\u003c/em\\u003e 0.64%; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) compared to HIV infected women.\\u003c/p\\u003e\\n\\u003cp\\u003ePrior to the pandemic, birth weight was lower (2.90\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.75 \\u003cem\\u003evs\\u003c/em\\u003e 2.97\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.74; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.005) in babies born to HIV-infected mothers compared to uninfected mothers; and the number of live births was lower 1,422 (77.16%) compared to during the pandemic 555 (39.61%);\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001. Of these births, a decline was noted amongst babies receiving Nevirapine postpartum 1,323 (71.86%) \\u003cem\\u003evs\\u003c/em\\u003e 546 (38.97%); \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001 and those receivingdaily doses 359 (19.53%) \\u003cem\\u003evs\\u003c/em\\u003e 262 (18.70%); \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001, prior to and during the pandemic. Noteworthy, the rate of eclampsia development was lower in HIV-infected pregnancies during the pandemic uninfected pregnancies (0.07% \\u003cem\\u003evs\\u003c/em\\u003e 0.68%; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). During the pandemic, sepsis infection was higher in HIV-infected pregnancies compared to uninfected pregnancies (12.52% \\u003cem\\u003evs\\u003c/em\\u003e 7.96%; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAssociation between HIV and infant birth outcomes during the COVID\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026ndash;\\u003c/strong\\u003e\\u003cstrong\\u003e19 pandemic\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSignificant associations were observed between HIV status and birth outcomes during the COVID\\u0026ndash;19 pandemic (Table\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e). Prior to the pandemic, HIV positive women had 1.23 times (OR: 1.23; 95% CI: 1.07, 1.41; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.004) significantly higher risk of delivery at \\u0026le;\\u0026thinsp;37 weeks. In contrast this risk was reduced to 1.06 times (OR: 1.06; 95% CI: 0.91, 1.23; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.47) likelihood during the pandemic, albeit non-significant. Additionally, HIV positive women were less likely to deliver at \\u0026ge;\\u0026thinsp;37 weeks during the pre-COVID\\u0026ndash;19 (OR: 0.81; 95% CI: 0.71, 0.94 \\u003cem\\u003evs\\u003c/em\\u003e OR: 1.23;95%CI:1.07,1.41;\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.004) and COVID\\u0026ndash;19 (OR: 0.94; 95% CI: 0.81, 1.10 \\u003cem\\u003evs\\u003c/em\\u003e OR: 1.06; 95% CI: 0.91, 1.24; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.47) periods in comparison to HIV-uninfected women. Despite non-significance, HIV positive women had 0.97 times (OR: 0.97; 95% CI: 0.84, 1.12; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.70) lower risk of requiring emergency caesarean section (C/S) during the pandemic. However, the likelihood of elective C/S during this period amongt HIV positive women was high(OR: 1.21; 95% CI: 0.97, 1.52; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.09). Moreover, a higher risk of stillbirth was associated with positive HIV status, with a 1.28 (OR: 1.28; 95% CI: 0.93, 1.76; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.13) and 1.37 (OR: 1.37; 95% CI: 0.94, 1.99; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.10) times likelihood of stillbirth during the pre-COVID-19 periods, respectively. In contrast, HIV-uninfected women had a lower risk of stillbirth prior to (OR: 0.78; 95% CI: 0.57, 1.08; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.13) and during (OR: 0.73; 95% CI: 0.50, 1.06; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.10) the pandemic.\\u003c/p\\u003e\\n\\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003cdiv class=\\\"colspec\\\" align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/div\\u003e\\n \\u003cdiv class=\\\"colspec\\\" align=\\\"char\\\"\\u003e\\u0026nbsp;\\u003c/div\\u003e\\n \\u003ctable id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eAssociations between maternal age, gravidity and parity on complications of labour and birth outcomes\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth colspan=\\\"4\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHIV negative\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth colspan=\\\"4\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHIV positive\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth colspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePre-COVID-19 (n\\u0026thinsp;=\\u0026thinsp;3011)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth colspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCOVID (n\\u0026thinsp;=\\u0026thinsp;2196)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth colspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePre-COVID-19 (n\\u0026thinsp;=\\u0026thinsp;1849)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth colspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCOVID (n\\u0026thinsp;=\\u0026thinsp;1407)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOR (95% CI)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ep-value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOR (95% CI)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ep-value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOR (95% CI)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ep-value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOR (95% CI)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ep-value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGestational age at birth\\u003c/strong\\u003e:\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026lt;\\u0026thinsp;37 weeks\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.06 (0.91, 1.24)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.94 (0.81, 1.10)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.23 (1.07, 1.41)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.004**\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.06 (0.91, 1.23)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026gt;\\u0026thinsp;37 weeks\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.23 (1.07, 1.41)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.004**\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.06 (0.91, 1.24)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.81 (0.71, 0.94)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.004**\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.94 (0.81, 1.10)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCaesarean section\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eEmergency\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.01 (0.90, 1.14)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.87\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.02 (0.89, 1.19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.70\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.99 (0.88, 1.11)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.84\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.97 (0.84, 1.12)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.70\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eElective\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.05 (0.82, 1.35)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.68\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.82 (0.66, 0.13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.09\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.95 (0.74, 1.21)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.68\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.21 (0.97, 1.52)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.09\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eStillbirth\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.78 (0.57, 1.08)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.73 (0.50, 1.06)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.28 (0.93, 1.76)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.37 (0.94, 1.99)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBirth weight\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eExtremely low\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.70 (0.43, 1.16)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.42 (0.86, 2.33)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eVery low\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.10 (0.71, 1.72)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.91 (0.58, 1.42)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eLow\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.96 (0.66, 1.38)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.81\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.00 (0.71, 1.41)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.99\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.04 (0.72, 1.51)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.81\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.00 (0.71, 1.41)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.99\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eNormal\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.16 (0.83, 1.62)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.38\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.03 (0.77, 1.39)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.83\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.86 (0.62, 1.20)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.97 (0.72, 1.30)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.83\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eHigh\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.62 (1.02, 2.58)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.04*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.87 (0.56, 1.37)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.56\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.62 (0.39, 0.98)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.04*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.14 (0.73, 1.79)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.56\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAPGAR 5min\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eLow\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.52 (0.05, 5.05)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.57\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.91 (0.57, 1.45)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.69\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.93 (0.20, 18.89)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.57\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.10 (0.69, 1.75)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.69\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eIntermediate\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.52 (0.05, 5.12)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.58\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.91 (0.20, 18.70)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.58\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eNormal\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.54 (0.06, 5.23)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.60\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.63 (0.43, 0.92)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.02*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.83 (0.19, 17.67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.60\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.59 (1.09, 2.31)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.02*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAPGAR 10min\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eLow\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.62 (0.34, 1.15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.76 (0.34, 1.72)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.51\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.61 (0.87, 2.97)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.32 (0.58, 2.98)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.51\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eIntermediate\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eNormal\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.69 (0.40, 1.18)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.53 (0.25, 1.13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.46 (0.85, 2.50)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.89 (0.88, 4.04)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003ctfoot\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"9\\\"\\u003e*p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05; **p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.005; ***p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.00 considered statistically significant.\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tfoot\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eBabies born to HIV\\u0026ndash;positive women were 0.97 times (OR: 0.97; 95% CI: 0.72, 0.30; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.83) less likely to be within the normal birth weight range during the pandemic in comparison to HIV\\u0026ndash;negative women (OR: 1.03; 95% CI: 0.77, 1.39; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.83). During the pandemic, the risk of delivering extremely LBW babies is almost doubled in HIV\\u0026ndash;positive pregnant women (OR: 1.42; 95% CI: 0.86, 2.33; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.17) compared to HIV\\u0026ndash; negative women (OR: 0.70; 95% CI: 0.43, 1.16; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.17). Interestingly, during the pandemic, HIV\\u0026ndash;positive women were 1.14 times (OR: 1.14; 95% CI: 0.73, 1.79; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.56) more likely to deliver a baby of high birth weight, while this risk was 0.87 times (OR: 0.87; 95% CI: 0.56, 1.37; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.56) lower in HIV\\u0026ndash;negative women. During the pandemic, babies born to HIV positive mothers were more likely to produce low 5 minute APGAR scores in comparison to HIV-uninfected women during the pre-COVID-19 (OR: 1.93; 95% CI: 0.20, 18.89 \\u003cem\\u003evs\\u003c/em\\u003e OR: 0.52; 95% CI: 0.05, 5.05; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.57) and lockdown (OR: 1.10; 95% CI: 0.69, 1.75 \\u003cem\\u003evs\\u003c/em\\u003e OR: 0.91; 95% CI: 0.57, 1.45; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.69) periods. However, it is interesting to note that during the pandemic, HIV\\u0026ndash;positive pregnant women also demonstrated a significant 1.5 fold increase (OR: 1.59; 95% CI: 1.09, 2.31; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.02) in the odds of delivering babies that had a normal 5 minute APGAR score in comparison to HIV\\u0026ndash;negative women, where the odds of this was significantly reduced (OR: 0.63; 95% CI: 0.43, 0.92; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.02). A similar trend was followed with 10 minute APGAR scores, where babies born to HIV\\u0026ndash;positive women had a higher likelihood of low APGAR scores compared to those of HIV\\u0026ndash;negative mothers during the pre-COVID\\u0026ndash;19 (OR: 1.61; 95% CI: 0.87, 2.97 \\u003cem\\u003evs\\u003c/em\\u003e OR: 0.62; 95% CI: 0.34, 1.15; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.13) and the COVID\\u0026ndash;19 (OR: 1.32; 95% CI: 0.58, 2.98 \\u003cem\\u003evs\\u003c/em\\u003e OR: 0.76; 95% CI: 0.34, 1.72; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.51) periods. Of interest, normal 10 minute APGAR scores were also more likely to be associated with babies born from HIV\\u0026ndash;positive in comparison to HIV\\u0026ndash;negative women during the pre-COVID\\u0026ndash;19 (OR: 1.46; 95% CI: 0.85, 2.50 \\u003cem\\u003evs\\u003c/em\\u003e OR: 0.69; 95% CI: 0.40, 1.18; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.17) and COVID\\u0026ndash;19 (OR: 1.89; 95% CI: 0.88, 4.04 \\u003cem\\u003evs\\u003c/em\\u003e OR: 0.53; 95% CI: 0.25, 1.13; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.10) periods.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eOur findings demonstrate a significant difference in maternal demographic and clinical characteristics among HIV-infected pregnant women accessing hospital based antenatal care prior to compared to during the COVID-19 pandemic, on a decrease in overall hospital attendance was noted during the pandemic, aligning with global reports of reduced maternal health service utilization due to movement restrictions, fear of contracting SARS-CoV-2, and resource reallocation within health systems [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e]. Albeit this reduction was higher among HIV-infected women, confirming the adverse impact of the pandemic\\u0026rsquo;s on access to HIV care and antenatal services, as previously reported in sub-Saharan Africa [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]. Our findings also highlight a statistically significant difference for maternal age, gravidity, and parity between the 2 study periods (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Most of HIV-infected women were aged 19\\u0026ndash;35 years and were predominantly multigravida and multiparous, consistent with previous reports that women of reproductive age with extensive obstetric histories, are at an elevated risk for HIV acquisition and transmission [\\u003cspan additionalcitationids=\\\"CR31\\\" citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eNoteworthy, HIV-infection is associated with a higher cumulative childbirth and sexual exposure, whereas antenatal care booking patterns remained suboptimal for HIV-infected women, with persistent late bookings delaying the timely initiation of prevention of mother-to-child transmission interventions, thus corroborating previous reports [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e]. Alarmingly, most women did not meet the WHO recommended minimum of eight ANC visits, a deficit that worsened during the pandemic, reflecting ongoing challenges in maternal health service delivery and utilization [\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eRegarding the ART regimen data, a slight increase was observed in dual fixed-dose combination (FDC) ART usage in contrast to a decrease in triple ART regimens among HIV-infected women. This discrepancy may be due to the implementation of a more simplified treatment protocol, or public health modifications, and/or revised guidelines endorsing dual therapy, all of which may have focused on ensuring continuity of ART while minimizing COVID-19 exposure risk [\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]. Despite these disruptions, there was a notable reduction in the proportion of HIV-infected pregnant women with elevated viral loads (\\u0026gt;\\u0026thinsp;1,000 copies/mL and \\u0026gt;\\u0026thinsp;10,000 copies/mL), which may be attributed to effective maintenance of virologic suppression among those retained in care.\\u003c/p\\u003e\\u003cp\\u003eBirth outcomes showed that majority of women delivered at term (\\u0026ge;\\u0026thinsp;37 weeks\\u0026rsquo; gestation) in both study intervals. Our findings corroborate Molina et al (2022), who reported a stabilisation in the rate of preterm births before and during covid-19 [\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]. We also observed a reduction in the number of preterm births during the pandemic, which aligns with previous reports [\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e], however this may be attributed to reduced working hours, decreased physical and/or emotional stress associated with employment, a decrease in infections due to improved hygiene and reduced social interactions, lower rates of smoking and substance abuse, the presence of familial support at home, increased time for physical exercise, reduced exposure to environmental pollutants, and less vehicular travel, resulting in decreased stress and fewer accident [\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eAdditionally, we demonstrate significantly shorter duration of active labour in women with HIV compared towomen without, both before and after the COVID-19 pandemic. Our findings corroborate previous reports, which indicate that prolonged labour increases the risk of mother-to-child HIV transmission, HIV infected women typically have shorter active labour periods than uninfected women [\\u003cspan additionalcitationids=\\\"CR41\\\" citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]. Current clinical management plans strive to reduce the duration of labour as a means to reduce foetal exposure to the virus through maternal blood and cervical secretions [\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]. More recently, an association between HIV infection and changes in myometrial function and/or hyperinflammatory activity was reported, suggestive of an ameliorative effect on labour progression[\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e]. Overall, data regarding modes of delivery failed to demonstrate any significance between the 2 study intervals; however, caesarean section rates increased during the pandemic for both HIV-infected and uninfected women. The low rates of vacuum and forceps deliveries are consistent with longstanding limitations in many African settings [\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e], which was further decreased during the pandemic perhaps due to concerns about prolonged close contact with potentially infectious patients and staff shortages.\\u003c/p\\u003e\\u003cp\\u003eDuring the pandemic, we observed a slight decrease in breech presentations, labour inductions, and miscarriages among HIV-infected women, and surprisingly no maternal deaths in either group across both study intervals. These findings suggests that the local healthcare systems strived to maintain high standards of maternal care during and after the pandemic, irrespective of HIV status. Both live births and stillbirths decreased during the COVID-19 pandemic, which is inconsistent with that reported by Galis and coworkers, who demonstrated an increase in the stillbirth rate during COVID-19 pandemic (RR: 1.53, 95% CI, 1.05\\u0026ndash;2.23) [\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e]. The data from prior to the pandemic, highlights normal APGAR scores between five and ten minutes after birth as well as a reduction in newborn resuscitation rates regardless of the mother's HIV status. In contrast, during the pandemic, fewer HIV-infected women had babies with normal APGAR scores, while HIV-uninfected women had comparatively lower or intermediate scores.\\u003c/p\\u003e\\u003cp\\u003eBirth weight was also significantly lower among infants born to HIV-infected mothers before the pandemic, a trend widely reported in the literature and attributed to HIV-associated placental dysfunction, chronic inflammation, and ART exposure [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e]. During the pandemic, obstetric complications like haemorrhage, preeclampsia, and obstructed labour were less common in women infected with HIV than those not infected. However, our findings differs from previous reports that highlight higher complication rates in HIV-infected pregnancies [\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR49\\\" citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e], indicative of HIV-infected women practicingdifferent health-seeking practices, visiting facilities, or changes in risk profiles [\\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e51\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eDuring the pandemic, we also demonstrated a higher incidence of sepsis among women with HIV. Studies indicate that HIV infection can induce immunosuppression, subsequently resulting in a broader spectrum of aetiologies that can promote the onset of sepsis [\\u003cspan citationid=\\\"CR52\\\" class=\\\"CitationRef\\\"\\u003e52\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR53\\\" class=\\\"CitationRef\\\"\\u003e53\\u003c/span\\u003e]. Prior to the pandemic, we report a higher of preterm delivery (\\u0026le;\\u0026thinsp;37 weeks) among HIV-infected women, which concur with Naidoo and coworkers, who reported that HIV-infected mothers were significantly more\\u0026thinsp;~\\u0026thinsp;4 fold likelyto have preterm deliveries than their HIV-uninfected counterparts [\\u003cspan citationid=\\\"CR54\\\" class=\\\"CitationRef\\\"\\u003e54\\u003c/span\\u003e]. Additionally, reports confirm a higher risk of Preterm Birth\\u0026thinsp;\\u0026lt;\\u0026thinsp;37 weeks among HIV infected women than those without (32% vs. 23%, RR\\u0026thinsp;=\\u0026thinsp;1.43, 95% Cl: 1.07\\u0026ndash;1.91) [\\u003cspan citationid=\\\"CR55\\\" class=\\\"CitationRef\\\"\\u003e55\\u003c/span\\u003e]. However, our bivariate analysis showed no correlation between maternal HIV statu and the incidence of preterm delivery during the pandemic. Albeit previous studies confirmed that HIV-infected women, especially those with uncontrolled infection or without ART, had a higher risk of preterm birth due to immune activation and systemic inflammation [\\u003cspan citationid=\\\"CR56\\\" class=\\\"CitationRef\\\"\\u003e56\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR57\\\" class=\\\"CitationRef\\\"\\u003e57\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eOur findings concur with Mugo and colleagues, who suggests that with effective ART, HIV infection itself may not significantly increase preterm delivery risk [\\u003cspan citationid=\\\"CR58\\\" class=\\\"CitationRef\\\"\\u003e58\\u003c/span\\u003e]. During the pandemic, the disruptions in healthcare access and consequent elevations in stress levels may have influenced the risk of preterm birth regardless of the HIV status. Further research is needed to fully understand the complex interplay between HIV, ART, and preterm birth, particularly the specific mechanisms that might lead to an increased risk in some cases.\\u003c/p\\u003e\\u003cp\\u003eHIV-infected women also exhibited a non-significant reduction in risk for emergency caesarean section During the pandemic, there was a notable trend towards increased elective caesarean deliveries amongst HIV infected women. Elective caesareans are the preferred delivery options taken by HIV-infected women to reduce vertical transmission risk [\\u003cspan citationid=\\\"CR59\\\" class=\\\"CitationRef\\\"\\u003e59\\u003c/span\\u003e], particularly when viral suppression is suboptimal [\\u003cspan citationid=\\\"CR60\\\" class=\\\"CitationRef\\\"\\u003e60\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR61\\\" class=\\\"CitationRef\\\"\\u003e61\\u003c/span\\u003e]. The shift observed during the pandemic may reflect a change in hospital policies and a preference for planned interventions to limit both maternal and staff exposure to viral exposure.\\u003c/p\\u003e\\u003cp\\u003eOur findings also highlight an association between HIV infection and lower birth weight before the pandemic and higher birth weight during the pandemic, albeit non-significant. The analysis showed that, HIV-infected women were more likely to deliver infants with low 5 and 10 minute APGAR scores during both periods, there was a significant increase in the odds of normal APGAR scores among infants born to HIV-infected mothers during the pandemic, compared to HIV-uninfected women.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003e\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eThis study highlights how the COVID-19 pandemic caused major disruptions to HIV services and prenatal care for pregnant women, particularly those with HIV, which resulted in fewer hospital visits and difficulties in sustaining the best possible care. Modifying management plans such as updated ART regimes helped maintain viral suppression among women with HIV despite these interruptions. Pregnancy outcomes were still influenced by maternal HIV status; before the pandemic, HIV-positive women had different labour patterns and obstetric risks. However, during the pandemic, some disparities, like the risk of preterm birth, decreased, perhaps because of multifactorial factors like improved HIV management and changes in healthcare access. Notably, constant maternal mortality and some improved newborn indicators suggested that overall maternal care quality was durable during the pandemic, even though poor birth outcomes were still higher among women with HIV. These results demonstrate how crucial it is to continue providing specialised HIV and maternity care during medical emergencies to protect vulnerable groups.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cem\\u003eAcknowledgements\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors thank the Labour Ward staff at the local tertiary affiliated hospital for their support in accessing the data.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eContribution to authorship\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNG and JM conceptualised the study. SR performed the analysis. SR and ZM drafted the manuscript. All authors commented on and edited the manuscript\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026nbsp;Funding\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was funded by the National Research Foundation of South Africa (grant number SRUG2205056757).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eData availability statement\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available because of privacy or ethical restrictions\\u003c/p\\u003e\\n\\u003cp\\u003eConflict of interest: No potential conflict of interest was reported by the authors\\u003cem\\u003e.\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eConsent to participate\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInformed consent was obtained from all individual participants included in the study\\u003cem\\u003e.\\u003c/em\\u003e\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eUNAIDS. Global AIDS Update 2024 \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.unaids.org/en/resources/fact-sheet\\u003c/span\\u003e\\u003cspan address=\\\"https://www.unaids.org/en/resources/fact-sheet\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eGratton S-M, Choudhry AJ, Vilos GA, Vilos A, Baier K, Holubeshen S, et al. Diagnosis of endometriosis at laparoscopy: a validation study comparing surgeon visualization with histologic findings. JOGC. 2022;44(2):135\\u0026ndash;41.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eWorld Health Organization. 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Viruses. 2024;16(12):1822.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMolina RL, Tsai TC, Dai D, Soto M, Rosenthal N, Orav EJ, et al. Comparison of pregnancy and birth outcomes before vs during the COVID-19 pandemic. JAMA network open. 2022;5(8):e2226531\\u0026ndash;e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eDelius M, Kolben T, Nu\\u0026szlig;baum C, Bogner-Flatz V, Delius A, Hahn L, et al. Changes in the rate of preterm infants during the COVID-19 pandemic Lockdown Period\\u0026mdash;Data from a large tertiary German University Center. Arch. Gynecol. Obstet. 2024;309(5):1925\\u0026ndash;33.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBerghella V, Boelig R, Roman A, Burd J, Anderson K. Decreased incidence of preterm birth during coronavirus disease 2019 pandemic. Am. J. Obstet. Gynecol. MFM. 2020;2(4):100258.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eOnyekwena RPS, Samuel ES. 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Res. 2025;30(1):494.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eNaidoo M, Sartorius B, Tshimanga-Tshikala G. Maternal HIV infection and preterm delivery outcomes at an urban district hospital in KwaZulu-Natal 2011. SAJID and S Afr J Infect Dis. 2016;31(1):25\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eVenkatesh KK, Edmonds A, Westreich D, Dionne-Odom J, Weiss DJ, Sheth AN, et al. Associations between HIV, antiretroviral therapy and preterm birth in the US Women\\u0026rsquo;s Interagency HIV Study, 1995\\u0026ndash;2018: a prospective cohort. HIV Med. 2022;23(4):406\\u0026ndash;16.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eIkumi NM, Matjila M. Preterm birth in women with HIV: the role of the placenta. Front. Glob. Women's Health. 2022;3:820759.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eShinar S, Agrawal S, Ryu M, Walmsley S, Serghides L, Yudin MH, et al. Perinatal outcomes in women living with HIV-1 and receiving antiretroviral therapy\\u0026mdash;a systematic review and meta‐analysis. Acta Obstet. Gynecol. Scand. 2022;101(2):168\\u0026ndash;82.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMugo C, Nduati R, Osoro E, Nyawanda BO, Mirieri H, Hunsperger E, et al. Comparable pregnancy outcomes for HIV-uninfected and HIV-infected women on antiretroviral treatment in Kenya. J. Infect. Dis. 2022;226(4):678\\u0026ndash;86.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSebitloane HM. Is there still a role for Caesarean section in preventing vertical HIV transmission in the era of highly active antiretroviral therapy? S. Afr. fam. pract. 2013;55(2):164\\u0026ndash;7.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003ePregnancy PoToHD, Transmission PoP. Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States. 2024.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCerveny L, Murthi P, Staud F. HIV in pregnancy: Mother-to-child transmission, pharmacotherapy, and toxicity. Biochim. Biophys. Acta Mol. Basis Dis. 2021;1867(10):166206.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"archives-of-gynecology-and-obstetrics\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"arch\",\"sideBox\":\"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/arch/default.aspx\",\"title\":\"Archives of Gynecology and Obstetrics\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false},\"keywords\":\"COVID–19, human immunodeficiency virus (HIV), perinatal birth outcomes, pregnancy complication\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7508995/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7508995/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground:\\u003c/strong\\u003e Maternal HIV infection is associated with increased risks of pregnancy complications and adverse perinatal outcomes, particularly in high-prevalence settings like South Africa. The COVID-19 pandemic disrupted healthcare access, potentially exacerbating challenges in antenatal care and HIV management. To our knowledge, limited South African data exists regarding the impact of maternal HIV on birth complications and perinatal birth outcomes especially during the COVID-19 pandemic.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAim:\\u003c/strong\\u003e This study thus evaluates the impact of maternal HIV on pregnancy and perinatal outcomes before and during the COVID-19 pandemic using archived chart records from a tertiary hospital in KwaZulu-Natal, South Africa.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods:\\u003c/strong\\u003e A retrospective analysis of 8,463 birth records from March 2019 to December 2020 was conducted, categorized into pre-pandemic and pandemic periods. Data were stratified by maternal HIV status and analyzed for demographics, antenatal care attendance, ART regimens, labor characteristics, and birth outcomes. Statistical tests including chi-square and logistic regression were used to assess associations between HIV status and outcomes.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults:\\u003c/strong\\u003e Hospital attendance declined during the pandemic, especially among HIV-infected women. HIV-positive women were predominantly aged 19–35, multigravida, and multiparous. Antenatal care attendance was suboptimal and worsened during the pandemic. ART coverage remained high with maintained viral suppression. HIV-positive women had shorter active labor and higher elective cesarean rates during the pandemic. Preterm birth risk was higher pre-pandemic among HIV-positive women but not significantly different during the pandemic. Birth weights were lower in HIV-exposed infants pre-pandemic with a non-significant shift during the pandemic. Sepsis incidence increased among HIV-infected women during the pandemic. No maternal deaths were reported.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion:\\u003c/strong\\u003eThe COVID-19 pandemic significantly disrupted prenatal and HIV care for pregnant women, but effective HIV management maintained some protective effects. Maternal HIV remains a critical factor influencing birth outcomes, necessitating sustained focus on tailored care during crises to protect vulnerable populations.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Impact of Maternal HIV Infection on Pregnancy and Labour Complication and Perinatal Health Outcomes: A South African Retrospective Study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-10-03 15:09:40\",\"doi\":\"10.21203/rs.3.rs-7508995/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-11-27T15:01:29+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-10-09T13:32:15+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"194910888691939833815018828304905952258\",\"date\":\"2025-09-30T06:54:40+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-09-23T12:13:52+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"164964829644593798927224534631834739818\",\"date\":\"2025-09-23T08:48:20+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-09-22T11:13:38+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-09-05T15:00:06+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-09-02T15:04:54+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Archives of Gynecology and Obstetrics\",\"date\":\"2025-09-01T13:29:45+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"archives-of-gynecology-and-obstetrics\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"arch\",\"sideBox\":\"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/arch/default.aspx\",\"title\":\"Archives of Gynecology and Obstetrics\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false}}],\"origin\":\"\",\"ownerIdentity\":\"ba0db0b0-04b9-4389-a606-d29778997513\",\"owner\":[],\"postedDate\":\"October 3rd, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-02-23T16:09:03+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-7508995\",\"link\":\"https://doi.org/10.1007/s00404-026-08347-w\",\"journal\":{\"identity\":\"archives-of-gynecology-and-obstetrics\",\"isVorOnly\":false,\"title\":\"Archives of Gynecology and Obstetrics\"},\"publishedOn\":\"2026-02-19 15:59:38\",\"publishedOnDateReadable\":\"February 19th, 2026\"},\"versionCreatedAt\":\"2025-10-03 15:09:40\",\"video\":\"\",\"vorDoi\":\"10.1007/s00404-026-08347-w\",\"vorDoiUrl\":\"https://doi.org/10.1007/s00404-026-08347-w\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7508995\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7508995\",\"identity\":\"rs-7508995\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}