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Antiretroviral therapy during pregnancy and risk of preterm birth

Louise-Helene Gagnon1, Jay MacGillivray2, Marcelo L Urquia3

  • 1Department of Obstetrics and Gynecology, University of Toronto, Canada.

European Journal of Obstetrics, Gynecology, and Reproductive Biology
|April 10, 2016
PubMed

Insights

Antiretroviral therapy (ART) in pregnancy may increase risks of preterm birth, low birth weight, and small for gestational age infants. However, adjusted analyses in this study lacked statistical significance due to limited power, suggesting a need for larger research.

Area of Science:

  • Obstetrics and Gynecology
  • Infectious Diseases
  • Neonatal Health

Background:

  • Antiretroviral therapy (ART) use during pregnancy, particularly protease inhibitor (PI) regimens, is linked to adverse infant outcomes like preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA).
  • Existing literature presents conflicting data on the magnitude of these risks, potentially due to demographic factors and confounding variables such as maternal HIV status and immune suppression levels.

Purpose of the Study:

  • To evaluate the risk of PTB in HIV-positive pregnant women on ART compared to HIV-negative pregnant women.
  • To compare the risks of LBW and SGA infants between these two groups.
  • To specifically assess PTB, LBW, and SGA risks in women on PI-based ART regimens versus controls.

Main Methods:

  • A retrospective matched cohort study involving 384 women from 2007-2012.
  • Comparison of adverse infant outcomes between HIV-positive women on ART and HIV-negative women.
  • Utilized univariate and multivariable logistic regression, adjusting for confounding factors like race.

Main Results:

  • Unadjusted analyses indicated over a two-fold increase in PTB, LBW, and SGA rates for HIV-positive women on ART.
  • After adjusting for race, the increased odds ratios for PTB, LBW, and SGA were no longer statistically significant.
  • The study was underpowered to detect smaller differences, with adjusted odds ratios for PTB (1.4), LBW (1.9), and SGA (1.8) not reaching statistical significance.

Conclusions:

  • Preliminary findings suggest a potential increase in PTB, LBW, and SGA associated with ART use in pregnancy.
  • Adjusted results were not statistically significant due to insufficient study power.
  • A larger, prospective study is recommended to confirm these preliminary findings and explore the associations further.
Abstract

Keywords:
Antiretroviral therapyHIVLow birth weightPregnancyPreterm birthSmall for gestational age

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