{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T09:43:16Z","timestamp":1761644596499,"version":"build-2065373602"},"reference-count":61,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Implementation of universal antiretroviral treatment (ART) in pregnancy has improved maternal health and reduced vertical transmission. However, women living with HIV (WLHIV) still experience worse perinatal outcomes. This retrospective study compared demographic, virological factors, ART regimens and perinatal outcomes in pregnant WLHIV between 2000\u20132010 (n = 318) and 2011\u20132021 (n = 140) at a tertiary center in Barcelona. Significant demographic shifts included changes in ethnic distribution, substance use, educational attainment, and maternal BMI. Significant progress in infection control was observed, with increased ART coverage up to 97%, improved viral suppression (80% to 91.3%, p = 0.002), and enhanced immunological status. ART regimens shifted significantly, with an increase in integrase strand transfer inhibitors (INSTI)-based regimens (0.7% to 39.2%, p &lt; 0.001). Obstetric management evolved, with a rise in vaginal deliveries (24.8% to 44.3%, p &lt; 0.001) and a decline in intrapartum zidovudine (93.7% to 54.7%, p &lt; 0.001). Notably, preterm birth rates sharply declined, yet small-for-gestational-age (SGA) infants (26.4% vs. 20%, p = 0.323) and preeclampsia rates remained unchanged and higher than in the general population. All statistical analyses were performed in IBM SPSS statistics 23. In conclusion, although maternal and perinatal outcomes in pregnant WLHIV have improved over the past two decades, a high rate of adverse perinatal outcomes related to placental dysfunction (SGA, preeclampsia) persist. Our findings highlight the need for optimized prenatal care and further research to develop targeted interventions for WLHIV.<\/jats:p>","DOI":"10.3390\/v17111425","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T09:16:07Z","timestamp":1761642967000},"page":"1425","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Two Decades of Change: Evolving Maternal Characteristics and Perinatal Outcomes in Pregnant Women Living with HIV"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5869-7109","authenticated-orcid":false,"given":"Laura","family":"Salazar","sequence":"first","affiliation":[{"name":"Department of Maternal-Fetal Medicine, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital Sant Joan de D\u00e9u), 08028 Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"},{"name":"Faculty of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Gonc\u00e9","sequence":"additional","affiliation":[{"name":"Department of Maternal-Fetal Medicine, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital Sant Joan de D\u00e9u), 08028 Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"},{"name":"Faculty of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabel","family":"Matas","sequence":"additional","affiliation":[{"name":"Department of Maternal-Fetal Medicine, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital Sant Joan de D\u00e9u), 08028 Barcelona, Spain"},{"name":"Faculty of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judit","family":"Balcells","sequence":"additional","affiliation":[{"name":"Department of Maternal-Fetal Medicine, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital Sant Joan de D\u00e9u), 08028 Barcelona, Spain"},{"name":"Faculty of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Garc\u00eda-Otero","sequence":"additional","affiliation":[{"name":"Department of Maternal-Fetal Medicine, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital Sant Joan de D\u00e9u), 08028 Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"},{"name":"Faculty of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cl\u00e0udia","family":"Fortuny","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Pediatrics Department, Institut de Recerca Hospital Sant Joan de D\u00e9u (Hospital Sant Joan de D\u00e9u), 08950 Esplugues de Llobregat, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Berta","family":"Torres","sequence":"additional","affiliation":[{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"},{"name":"HIV\/AIDS Unit, Infectious Diseases Department, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"},{"name":"Center for Biomedical Network Research on Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0894-3711","authenticated-orcid":false,"given":"Ana","family":"Gonz\u00e1lez-Cord\u00f3n","sequence":"additional","affiliation":[{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"},{"name":"HIV\/AIDS Unit, Infectious Diseases Department, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"},{"name":"Center for Biomedical Network Research on Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Montse","family":"Palacio","sequence":"additional","affiliation":[{"name":"Department of Maternal-Fetal Medicine, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital Sant Joan de D\u00e9u), 08028 Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"},{"name":"Faculty of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Center for Biomedical Network Research on Rare Diseases (CIBER-ER), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduard","family":"Gratac\u00f3s","sequence":"additional","affiliation":[{"name":"Department of Maternal-Fetal Medicine, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital Sant Joan de D\u00e9u), 08028 Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"},{"name":"Faculty of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Center for Biomedical Network Research on Rare Diseases (CIBER-ER), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesc","family":"Figueras","sequence":"additional","affiliation":[{"name":"Department of Maternal-Fetal Medicine, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital Sant Joan de D\u00e9u), 08028 Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"},{"name":"Faculty of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Center for Biomedical Network Research on Rare Diseases (CIBER-ER), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7422-5240","authenticated-orcid":false,"given":"Fatima","family":"Crispi","sequence":"additional","affiliation":[{"name":"Department of Maternal-Fetal Medicine, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital 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Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,27]]},"reference":[{"key":"ref_1","unstructured":"(2025). 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