OBJECTIVE: To explore the association between antiretroviral therapy in pregnancy and premature delivery, birthweight, stillbirth and neonatal mortality, in pregnancies in HIV-infected women delivering between 1990 and 2005. DESIGN: Pregnancies in women with diagnosed HIV infection in the UK and Ireland are notified to the National Study of HIV in Pregnancy and Childhood (NSHPC) through a well-established surveillance scheme. RESULTS: The prematurity rate (< 37 weeks gestation) was higher in women on highly active antiretroviral therapy (HAART) (14.1%, 476/3384) than in women on mono/dual therapy (10.1%, 107/1061), even after adjusting for ethnicity, maternal age, clinical status and injecting drug use as the source of HIV acquisition [adjusted odds ratio (AOR) = 1.51, 95% confidence interval (CI), 1.19-1.93; P = 0.001]. Delivery at < 35 weeks was even more strongly associated with HAART (AOR = 2.34; 95% CI, 1.64-3.37; P < 0.001). The effect was the same whether or not HAART included a protease inhibitor. In comparison with exposure to mono/dual therapy, exposure to HAART was associated with lower birthweight standardized for gestational age (P < 0.001), and an increased risk of stillbirth (AOR = 2.27; 95% CI, 0.96-5.41; P = 0.063). CONCLUSIONS: These findings, based on comprehensive population surveillance, demonstrate an increased risk of prematurity associated with HAART, and a possible association with other perinatal outcomes, including stillbirth and birthweight. Although the beneficial effects of antiretroviral therapy on mother-to-child transmission are indisputable, monitoring antiretroviral therapy in pregnancy remains a priority.
OBJECTIVE: To explore the association between antiretroviral therapy in pregnancy and premature delivery, birthweight, stillbirth and neonatal mortality, in pregnancies in HIV-infected women delivering between 1990 and 2005. DESIGN: Pregnancies in women with diagnosed HIV infection in the UK and Ireland are notified to the National Study of HIV in Pregnancy and Childhood (NSHPC) through a well-established surveillance scheme. RESULTS: The prematurity rate (< 37 weeks gestation) was higher in women on highly active antiretroviral therapy (HAART) (14.1%, 476/3384) than in women on mono/dual therapy (10.1%, 107/1061), even after adjusting for ethnicity, maternal age, clinical status and injecting drug use as the source of HIV acquisition [adjusted odds ratio (AOR) = 1.51, 95% confidence interval (CI), 1.19-1.93; P = 0.001]. Delivery at < 35 weeks was even more strongly associated with HAART (AOR = 2.34; 95% CI, 1.64-3.37; P < 0.001). The effect was the same whether or not HAART included a protease inhibitor. In comparison with exposure to mono/dual therapy, exposure to HAART was associated with lower birthweight standardized for gestational age (P < 0.001), and an increased risk of stillbirth (AOR = 2.27; 95% CI, 0.96-5.41; P = 0.063). CONCLUSIONS: These findings, based on comprehensive population surveillance, demonstrate an increased risk of prematurity associated with HAART, and a possible association with other perinatal outcomes, including stillbirth and birthweight. Although the beneficial effects of antiretroviral therapy on mother-to-child transmission are indisputable, monitoring antiretroviral therapy in pregnancy remains a priority.
Authors: Angela M Bengtson; Daniel Westreich; Patrick Musonda; Audrey Pettifor; Carla Chibwesha; Benjamin H Chi; Bellington Vwalika; Brian W Pence; Jeffrey S A Stringer; William C Miller Journal: Epidemiology Date: 2016-09 Impact factor: 4.822
Authors: Dorothy Sebikari; Mona Farhad; Terry Fenton; Maxensia Owor; Jeffrey S A Stringer; Min Qin; Nahida Chakhtoura; Benjamin H Chi; Friday Saidi; Neetal Nevrekar; Avy Violari; Tsungai Chipato; James A McIntyre; Dhayendre Moodley; Taha E Taha; Gerhard Theron; Mary Glenn Fowler Journal: J Acquir Immune Defic Syndr Date: 2019-08-15 Impact factor: 3.731
Authors: R Kreitchmann; S X Li; V H Melo; D Fernandes Coelho; D H Watts; E Joao; C M Coutinho; J O Alarcon; G K Siberry Journal: BJOG Date: 2014-03-07 Impact factor: 6.531
Authors: Kelesitse Phiri; Paige L Williams; Kate B Dugan; Michael A Fischer; William O Cooper; George R Seage; Sonia Hernandez-Diaz Journal: Pediatr Infect Dis J Date: 2015-07 Impact factor: 2.129
Authors: Jennifer Y Chen; Heather J Ribaudo; Sajini Souda; Natasha Parekh; Anthony Ogwu; Shahin Lockman; Kathleen Powis; Scott Dryden-Peterson; Tracy Creek; William Jimbo; Tebogo Madidimalo; Joseph Makhema; Max Essex; Roger L Shapiro Journal: J Infect Dis Date: 2012-10-12 Impact factor: 5.226
Authors: E S Machado; C B Hofer; T T Costa; S A Nogueira; R H Oliveira; T F Abreu; L A Evangelista; I F A Farias; R T C Mercadante; M F L Garcia; R C Neves; V M Costa; J S Lambert Journal: Sex Transm Infect Date: 2008-11-05 Impact factor: 3.519
Authors: Fernando C Barros; Zulfiqar Ahmed Bhutta; Maneesh Batra; Thomas N Hansen; Cesar G Victora; Craig E Rubens Journal: BMC Pregnancy Childbirth Date: 2010-02-23 Impact factor: 3.007