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302 SPO Abstracts

HIV SEROSTATUS AND REPRODUCTIVE CHOICE. Sunderland A Minkoff HL, Handte J~ Willoughby AX, Moroso GX, Landesman SX. SUNY Health Science Center at Brooklyn, New York, NICHD, Bethesda, MD.

Reproductive decisions of HIV infected women effect the extend of the pediatric HIV epidemic, but little is known about how serostatus influences such decisions, particularly among non­drug users (Non-DU). Between 1/86 and 11/89, 98 HIV(+) and 108 HIV(-) pregnant women from the same risk groups were entered into a longitudinal study.32(32%) HIV(+) and 33(30%) HIV(-) women entered prenatal care early enough in their index pregnancy to have the option of termination and 5(15%) HIV(+) and 1(3%) HIV(-) women elected termination (NS) . During follow-up, which ranged up to 4 years, 15% of drug using HIV(+) and 15% of drug using HIV(-) women had an additional live birth. Among non DUs however 8% of HIV(+) and 20% of HIV(-) had live births (P=.09). We found a trend toward serostatus influencing reproductive decisions among non DU women to a greater degree than has been reported among drug users.

MONONUCLEAR CELL INTERLEUKlN 1B PRODUCilON IN PREGNANCY: RESPONSE TO MITOGEN ACilVATION. Bernard Gonik. James Reuben', Lian Lao'. Depts Ob/Gyn/Repro ScI and Immunology The Univ of Texas and MD Anderson Cancer Clr, Houston, TIC

Mononuclear cell (MC)-derived cytokines such as interleukin IB (Ill B) are known to modulate cellular immune function. Since pregnancy is considered by some to be an immunocompromised state, we hypothesized that cytokine production response would be altered during pregnancy. MCs were isolated from 10 uncomplicated 2nd or 3rd trimester subjects (P) Short-term cell cultures were established in endotoxin-poor minimal essential media (MEM) with 10% fetal calf serum, with or wIthout the addition of 0.5% phytohemagglutinin (PHA) MCs from 5 nonpregnant controls (C) were concomitantly studied. Cell cultures were centrifuged, and tbe supernatants were assayed for ILlB using a sensitive and specific ELISA (Cistron BioteChnology). Mean ±. S.E. values (pg/mI) were as follows:

Day 1 Day 3 P"EM S52±.101· 774±.116

P'HA 3152±.90S'

C",,, 490±.132

C'HA 13l3±.23S'

6292±.41S'

5SS±.lOS

4404±.157'

-p<O.05 (compared to CM'M) ' p<0.05(compared to MEM)

Day 5 842±.129'

6628±.59S'

462±.43

5211±.404'

Day 7 S72±.113

SS16±.620'

S31±.1S2

4559±1031'

MCs from P demonstrated "resting" ILlB levels similar to or greater than C levels. PHA consistently increased ILlB levels in both P and C to a similar degree. Maximum induction of ILlB by PHA was first noted on Day 3, and remained relatively constant thereafter. These in vitro data suggest MCs from pregnant hosts maintain, or have augmented, Immune responsiveness as measured by cytokine production.

January 199 1 Am J Ob,tet (;,necol

203 INCIDENCE AND PREVALENCE OF HIV INFECTION IN A PRENATAL POPULATION UNDERGOING ROUTINE VOLUNTARY ANTIBODY SCREENING, JULY 1987 TO JUNE 1990. M Lindsay, H Peterson, S Willis, B. Slade, J Gramling, L Klein. Depts of GYN/OB and Lab Medicine. Emory University Atlanta, GA.

Objective: To monitor the incidence of HIV-1 infection and to characterize HIV risk behaviors in an urban prenatal population. Methods: We offered routine voluntary HIV antibody testing and requested self-reported HIV risk behavior proftles on all women registering for prenatal care. Results : From 7/87-6/90, 22,364 (95%) of women registering for prenatal care consented to antibody testing and completed risk behavior profues. Over 69% of seropositives were 16-25 years old, 88% were black and 74% were single. The HIV-1 seroprevalence was 5.2 per 1000. The cumulative incidence of HIV infection increased 1.5 fold (95% CI .93-2.61) from 3.5 per 1000 (1987-88) to 5.8 per 1000 (1989-90). The use of crack cocaine emerged as a significant risk factor for mfection (P< .01). Seventy percent of seropositive women had no self-identified risk factors for infection and would not have been detected with targeted screening. Nearly all infected women were asymptomatic. Conclusion: The increasing incidence of HIV-I infection in our prenatal patients indicate the need for continued routine voluntary HIV screening and risk behavior assessment.

204 SMOKABLE FREEBASE COCAINE (CRACK) USE IS A RISK FACTOR FOR HIV INFECTION IN INNER-CITY PARTURIENTS. M Lindsay, ] Gramling, H Peterson, S Willis, L Klein, Department of GYN/OB, Emory University, Atlanta, GA

Objective: To determine if crack use is an independent predictor of HIV infection among inner-<:ity parturients . Methods: All women registering for prenatal care between 7/89 - 6/90 were offered routine voluntary HIV antibody testing and asked to complete a self­administered HIV risk behavior questionnaire which included inquiries about crack use. 43 HIV positive cases were identified and compared to 430 randomly selected HIV negative controls. Odds ratio and 95% CI adjusted for potential confounders were obtained from a logistic regression model. Results: 95 % of parturients consented to antibody testing and completed risk behavior profUes. The demographic characteristics of cases and controls were comparable. The frequency of IVDA, STDS, IVDNpartner, HIV positivelpartner and Hx incarcerated Ipartner was greater in cases than controls (P < .05). A history of crack use was also greater in cases than control 21.4% vs 5.1 % (OR 5.2; 95% CI 4.3-6.1). A relationship that persisted after controlling for IVDA and STDS. (OR 2.5; 95% CI 1.5-3.6). Conclusion: Crack use is an independent risk factor for HIV infection. Future HIV risk reduction strategies must highlJght this association.