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HAART during pregnancy increased adverse birth outcomes
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Receiving highly active antiretroviral therapy during pregnancy was associated with adverse birth outcomes among women with HIV in Botswana, data published in the Journal of Infectious Diseases suggest.
“This was the largest study to date on birth outcomes among HAART-exposed women,” Roger Shapiro, MD, associate professor in the department of immunology and infectious diseases at the Harvard School of Public Health, told Infectious Diseases in Children. “We were concerned by the associations between HAART and adverse outcomes, which we saw despite controlling for many confounders.”
Roger Shapiro
Shapiro and colleagues conducted the study by reviewing obstetrical records of 33,148 women who delivered live births or still births with a gestational age of at least 20 weeks at six hospitals in Botswana from May 2009 to April 2011. Among the women with a known HIV status, 29.6% were HIV infected. Among those with a known initiation date for ART, 24% continued HAART from before pregnancy, 12% initiated HAART during pregnancy, 51% initiated zidovudine monotherapy during pregnancy and 13% received no treatment.
Among women with HIV, the rate for preterm delivery was 24% and the median gestational age was 34 weeks. HAART exposure before pregnancy was associated with preterm delivery. Compared with initiating zidovudine monotherapy, initiating HAART during pregnancy also increased the odds of preterm delivery. Maternal hypertension during pregnancy and anemia were also associated with preterm delivery.
The rate for small for gestational age infants among women with HIV was 18%. Continuing HAART from before pregnancy was associated with having a small for gestational age infant. In addition, initiating HAART during pregnancy was associated with having a small for gestational age infant vs. initiating zidovudine monotherapy. CD4 counts of 200 cell/mcL or less and maternal hypertension were also associated with small for gestational age infants.
The stillbirth rate among women with HIV was 5%, with a median gestational age of 32 weeks. Continuing HAART during pregnancy was associated with stillbirth, as was starting HAART during pregnancy instead of zidovudine monotherapy. CD4 counts of 200 cells/mcL or less and maternal hypertension were associated with stillbirth.
“We need to use HAART in pregnancy for the health of the women and to prevent mother-to-child transmission, but this study suggests that these benefits might come at some cost,” Shapiro said. “We need to better understand the underlying mechanism for this problem and ultimately find a way to fix it.”
Shapiro said that clinicians should monitor pregnancies more closely for possible complications. Expansion of obstetrical and neonatal services in countries such as Botswana, that have generalized HIV epidemics, might improve birth outcomes, he said.
Disclosure: Shapiro reports no relevant financial disclosures.
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