Anti-retroviral Therapy and Pregnancy Outcomes in Developing Countries: A Systematic Review

Alemu, Fekadu Mazengia; Yalew, Alemayehu Worku; Fantahun, Mesganaw; Ashu, Eta Ebasi

doi:10.21106/ijma.36

Cited by 26 publications

(24 citation statements)

References 44 publications

(39 reference statements)

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“…By reporting a non-significant burden of PTB with cART, our data are inconsistent with previous findings from other African or Asian settings in newborns, while PTB (15% to 30% in previous studies) was reported to be associated with cART compared to monotherapy used mainly for PMTCT purpose [ 13 , 14 ]. Onsets of PTB appeared more frequent with PI-based regimens [ 15 ], suggesting the need of closer obstetrical monitoring of HIV-infected ANC attendees receiving a second-line ART regimen, since the use of PI is known to favor PTB, especially when initiating cART prior to conception or during pregnancy [ 16 – 18 ].…”

Section: Discussioncontrasting

confidence: 99%

Preterm Birth and Low Birth Weight after In Utero Exposure to Antiretrovirals Initiated during Pregnancy in Yaoundé, Cameroon

et al. 2016

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BackgroundEffects of antiretroviral therapy (ART) on birth outcomes remain controversial.ObjectiveTo assess the impact of antenatal exposure to ART on the occurrence of preterm birth (PTB) and low birth weight (LBW).MethodsA cross-sectional study conducted at the Essos Hospital Center in Yaounde from 2008 to 2011 among HIV vertically exposed infants with two distinct maternal antiretroviral experiences: monotherapy group (Zidovudine, ZDV) and the combination ART group (cART). Mothers already receiving cART before pregnancy were ineligible. In both groups, events of PTB (<37 weeks) and LBW (<2,500g) were analyzed using univariate and multivariate logistic regression; with p<0.05 considered statistically significant.ResultsOf the 760 infants, 481 were born from cART-exposed mothers against 279 from maternal-ZDV. Median maternal CD4 count was 378 [interquartile range (IQR): 253–535] cells/mm3. Median duration of ART at onset of delivery was 13 [IQR: 10–17] weeks. In the cART-group, 64.9% (312/481) of mothers were exposed to Zidovudine/Lamuvidine/Nevirapine and only 2% (9/481) were on protease inhibitor-based regimens. Events of PTB were not significantly higher in the cART-group compared to the ZDV-group (10.2% vs. 6.4% respectively, p = 0.08), while onsets of LBW were significantly found in the cART-group compared to ZDV-group (11.6% vs. 7.2% respectively, p = 0.05). Other factors (parity, maternal age at delivery or CD4 cell count) were not associated with PTB.ConclusioncART, initiated during pregnancy, would be an independent factor of LBW. In the era of option B+ (lifelong ART to all HIV-pregnant women), further studies would guide towards measures limiting onsets of LBW.

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Section: Discussioncontrasting

confidence: 99%

Preterm Birth and Low Birth Weight after In Utero Exposure to Antiretrovirals Initiated during Pregnancy in Yaoundé, Cameroon

et al. 2016

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“…Fekadu et al, found that rate of preterm birth was 10% in women who were started on HAART before pregnancy. 9 In present study, incidence of preterm labor was 16%. Exclusive breastfeeding was practiced among seropositive women with live births in accordance with NACO guidelines.…”

Section: Discussionmentioning

confidence: 43%

Study of maternal and fetal outcome in HIV positive women on HAART therapy in a tertiary hospital

Shankar

Madhu

2019

Int J Reprod Contracept Obstet Gynecol

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Background: India has the third largest population of HIV. Moving from single dose nevirapine in labor to use of HAART treatment for all pregnant women and the outcome of the same was the subject of present study.Methods: Retrospective study of HIV positive pregnant women on HAART treatment admitted in labor room at Karnataka institute of medical sciences from June 2015 to December 2016. A retrospective analytical study of 93 women with HIV positive status on HAART therapy admitted in labor at KIMS was done by collecting data from case records. Baby follow up details were collected from ART center, KIMS.Results: Parameters studied were maternal and fetal outcomes. Maternal outcome in terms of mode of delivery, morbidity and mortality and fetal outcomes in terms of APGAR at birth, weight of the baby, NICU admission, incidence of meconium, still birth and intrauterine fetal demise, follow up of the babies at 6 weeks, 6 Months and 18 Months for seropositivity.Conclusions: HAART in pregnant women significantly improved the maternal and fetal outcomes.

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“…There have been conflicting data reported on birth outcomes among HIV-positive women who are on lifelong ART compared to HIV negative women. Some studies found that adverse birth outcomes, such as increased preterm deliveries, stillbirths and low birth weight, occurred more frequently among HEI [3][4][5][6][7][8]. Other studies found no association between use of ART and adverse birth outcomes [9,10].…”

Section: Introductionmentioning

confidence: 99%

Comparison of 6-week PMTCT outcomes for HIV-exposed and HIV-unexposed infants in the era of lifelong ART: Results from an observational prospective cohort study

et al. 2019

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BackgroundLifelong antiretroviral therapy (ART) reduces mother-to-child HIV transmission (MTCT) and improves maternal health. Data on the outcomes of HIV-exposed infants (HEI) compared to their unexposed counterparts in the era of universal ART is limited. We compared birth and 6-week outcomes among infants born to HIV-positive and HIV-negative women in Lesotho. Methods 941HIV-negative and 653 HIV-positive pregnant women were enrolled in an observational cohort to evaluate the effectiveness of prevention of mother-to-child HIV transmission (PMTCT) program after implementation of universal maternal ART in 14 health facilities. Pregnancy, delivery, birth, and 6-week data were collected through participant interviews and medical record review. DNA PCR testing for HEI was conducted within 2 weeks of birth and at around 6 weeks of age. Data were analysed to estimate the distribution of birth outcomes, mortality, HIV transmission and HIV-free survival at 6 weeks. ResultsHIV-positive women were older (mean age of 28.7 vs. 24.4 years) and presented for antenatal care earlier (mean gestational age of 23.0 weeks vs 25.3 weeks) than HIV-negative women. Prematurity was more frequent among HEI, 7.8% vs. 3.6%. There was no difference in rates of congenital anomalies between HEI (1.0%) and HIV-unexposed infants (HUI) (0.6%). Cumulative HIV transmission was 0.9% (N = 4/431) (95% CI:0.25-2.36) at birth and 1.0% (N = 6/583) (95% CI:0.38-2.23) at 6 weeks. Overall mortality, including PLOS ONE | https://doi.

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Anti-retroviral Therapy and Pregnancy Outcomes in Developing Countries: A Systematic Review

Cited by 26 publications

References 44 publications

Preterm Birth and Low Birth Weight after In Utero Exposure to Antiretrovirals Initiated during Pregnancy in Yaoundé, Cameroon

Preterm Birth and Low Birth Weight after In Utero Exposure to Antiretrovirals Initiated during Pregnancy in Yaoundé, Cameroon

Study of maternal and fetal outcome in HIV positive women on HAART therapy in a tertiary hospital

Comparison of 6-week PMTCT outcomes for HIV-exposed and HIV-unexposed infants in the era of lifelong ART: Results from an observational prospective cohort study

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