No relation between in-utero exposure to HAART and intrauterine growth retardation

The use of HAART during pregnancy is now standard care to prevent mother-to-child HIV transmission in developed countries. There is controversy about its impact on low birth weight.

To evaluate the impact of antiretroviral therapy during the pregnancy on birth weight, length and head circumference.

The study was performed in uninfected infants born to HIV-1-infected mothers, enrolled from 1990 to 2006 in the Agence Nationale de Recherche sur le SIDA French Perinatal Cohort CO1. We excluded mothers who used illicit drugs during pregnancy or had no prenatal care before the third trimester, twins and stillbirths. We used Z-scores adjusted for gestational age and sex.

In 8192 mother-infant pairs, the mean birth weight Z-scores increased between 1990 and 1997 and then remained stable until 2006. There was no significant relation between the type of antiretroviral therapy and the proportion of small for gestational age (birth weight Z-score < or = -2SD), which was 4% overall. Infants exposed to HAART compared with monotherapy had a lower mean birth weight Z-scores (difference -0.09, 95% confidence interval -0.15 to -0.02); however, there was no difference between HAART exposure in 2005-2006 and monotherapy in 1999-2004, which corresponded to standard care during each period, respectively. Length or head circumference Z-scores were not associated with antiretroviral therapy exposure. Among pregnancies with HAART, there was no relation between the duration and type of therapy and the anthropometric parameters.

Our findings in a large cohort suggest that HAART during pregnancy does not increase the incidence of infants who are small for gestational age.