Impact of Maternal HIV Infection on Pregnancy and Labour Complication and Perinatal Health Outcomes: A South African Retrospective Study

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.