Antiretroviral Therapy during Pregnancy and the Risk of an Adverse Outcome

Tuomala, Ruth; Shapiro, David E.; Mofenson, Lynne M.; Bryson, Yvonne J.; Culnane, Mary; Hughes, Michael D.; O'Sullivan, M. J.; Scott, Gwendolyn B.; Stek, Alice; Wara, Diane W.; Bulterys, Marc

doi:10.1056/nejmoa991159

Cited by 338 publications

(106 citation statements)

References 22 publications

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“…Analyzing the quality of pre-natal assistance and the deliveries in public maternities provided for pregnant women, we identified a reality that is far from what is recommended by the Ministry of Health, showing how fragile the Programa Brasileiro de Redução da TV do HIV (Brazilian Program to Reduce the Transmission of HIV), regarding its organization, management and health service assessment (24) . There were a higher percentage of women who had a normal delivery (39.80%) than in other studies (20.5% to 27.3%) (15,25) . The definition of normal delivery is based on the results of the maternal viral load (less than 1.000 copies/mL), conducted after the 34 th week of pregnancy, and in association with an obstetric evaluation (6) .…”

Section: Debatecontrasting

confidence: 64%

“…According to reports from HIV positive women who had seronegative children, we found that they were encouraged to seek assistance during their pregnancy (11) . The study found a percentage of approximately 85% compliance with pre-natal care, lower than what is found in Brazil (12,13) and in the world, with a variation of 90 to 100% (14,15). As for compliance with pre-natal care and childbirth ARV treatment, 82.6% and 77.3% pregnant women had prophylaxis treatment, respectively.…”

Section: Debatementioning

confidence: 62%

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HIV Pregnant Women WItH more tHan one Pregnancy and tHe Use of antIretroVIral dUrIng Pre-natal care and cHIldbIrtH

Chengyao¹,

Nichiata²

2013

J bra doenças sex transm

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Section: Debatecontrasting

confidence: 64%

Section: Debatementioning

confidence: 62%

HIV Pregnant Women WItH more tHan one Pregnancy and tHe Use of antIretroVIral dUrIng Pre-natal care and cHIldbIrtH

Chengyao¹,

Nichiata²

2013

J bra doenças sex transm

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“…In some studies that have compared HAART use to ZDV monotherapy, an increased risk of preterm delivery among HAART users has been reported 14, 15. However, Tuomala et al 16. reported on a combined analysis of five prospective cohorts and two randomised controlled trials, and did not find an effect of HAART on preterm delivery, in comparison to ZDV monotherapy (odds ratio 1.08, 95% CI 0.71–1.62).…”

Section: Discussionmentioning

confidence: 99%

“…In this study, no significant difference in risk of preterm delivery was observed between ZDV‐containing regimens and non‐ZDV ARV regimens. Among studies that examined LBW as an outcome, two African studies14, 17 found an increased risk of LBW with HAART exposure (either before pregnancy or antenatal exposure), whereas three others16, 18, 19 (two in the USA, one in Latin America and the Caribbean) found no effect. Data from this study indicated an increased risk for LBW among pregnancy outcomes with exposure to ZDV‐containing regimens, compared with non‐ZDV ARV regimens.…”

Section: Discussionmentioning

confidence: 99%

Association between in utero zidovudine exposure and nondefect adverse birth outcomes: analysis of prospectively collected data from the Antiretroviral Pregnancy Registry

Vannappagari

Koram

Albano

et al. 2015

BJOG

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ObjectiveTo examine the association between nondefect adverse birth outcomes and in utero exposure to zidovudine (ZDV)‐containing regimens versus non‐ZDV antiretroviral (ARV) regimens.DesignAnalysis of prospectively‐collected data.SettingGlobal.Population HIV‐infected pregnant women prenatally exposed to antiretrovirals.MethodsEstimation of prevalence of and risk for nondefect adverse birth outcomes among HIV‐infected women.Main outcome measuresPrevalence of and risk for nondefect adverse birth outcomes.ResultsAmong 12 780 singleton birth outcomes with in utero ZDV exposure, 96.1% were live births; 3.9% were spontaneous abortions, induced abortions or stillbirths. Among live births, 16.4% were low birthweight (LBW); 12.3% were premature. Among 1904 outcomes with in utero exposure to non‐ZDV ARV regimens, 85.8% were live births; 14.2% were spontaneous abortions, induced abortions or stillbirths. Among live births, 14.1% were LBW; 12.4% were premature. Relative risk comparing exposure to ZDV‐containing ARV regimens to non‐ZDV ARV regimens for spontaneous abortions was 0.18 (95% confidence interval [95% CI] 0.14–0.22); induced abortions 0.28 (95% CI 0.22–0.36); stillbirths 0.76 (95% CI 0.51–1.12); premature births 1.00 (95% CI 0.87–1.15) and LBW 1.17 (95% CI 1.02–1.33).ConclusionPrevalence of nondefect adverse birth outcomes is lower among outcomes with in utero ZDV exposure versus in utero non‐ZDV ARV exposure. The risks for spontaneous and induced abortions were no different for ZDV‐containing regimens versus non‐ZDV ARV regimens. For premature births and stillbirths, there was no significant difference in risk between the two regimens. The risk of LBW was statistically significantly higher among ZDV‐containing regimens versus non‐ZDV ARV regimens.Tweetable abstract ZDV‐containing regimens do not increase the risk for nondefect adverse birth outcomes.

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“…Additional measures including selective caesarean or avoidance of breastfeeding are strongly recommended. However, adverse pregnancy outcome have been increasingly reported by several observational studies in HIV‐infected women exposed to HAART 6, 7, 8, 9, 10, 11. Anti‐retrovirals and HIV‐infection have been associated with pre‐eclampsia, stillbirth, pre‐term labour, low birth weight and intrauterine growth restriction (IUGR) 12, 13, 14, 15, 16, 17.…”

Section: Introductionmentioning

confidence: 99%

Mitochondrial toxicity and caspase activation in HIV pregnant women

Hernández

Morén

Catalán-García

et al. 2016

J Cellular Molecular Medi

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To assess the impact of HIV‐infection and highly active anti‐retroviral treatment in mitochondria and apoptotic activation of caspases during pregnancy and their association with adverse perinatal outcome. Changes of mitochondrial parameters and apoptotic caspase activation in maternal peripheral blood mononuclear cells were compared at first trimester of pregnancy and delivery in 27 HIV‐infected and ‐treated pregnant women versus 24 uninfected pregnant controls. We correlated immunovirological, therapeutic and perinatal outcome with experimental findings: mitochondrial DNA (mtDNA) content, mitochondrial protein synthesis, mitochondrial function and apoptotic caspase activation. The HIV pregnancies showed increased adverse perinatal outcome (OR: 4.81 [1.14–20.16]; P < 0.05) and decreased mtDNA content (42.66 ± 5.94%, P < 0.01) compared to controls, even higher in naïve participants. This depletion caused a correlated decrease in mitochondrial protein synthesis (12.82 ± 5.73%, P < 0.01) and function (20.50 ± 10.14%, P < 0.001), not observed in controls. Along pregnancy, apoptotic caspase‐3 activation increased 63.64 ± 45.45% in controls (P < 0.001) and 100.00 ± 47.37% in HIV‐pregnancies (P < 0.001), in correlation with longer exposure to nucleoside analogues. HIV‐infected women showed increased obstetric problems and declined genetic and functional mitochondrial parameters during pregnancy, especially those firstly exposed to anti‐retrovirals. The apoptotic activation of caspases along pregnancy is emphasized in HIV pregnancies promoted by nucleoside analogues. However, we could not demonstrate direct mitochondrial or apoptotic implication in adverse obstetric outcome probably because of the reduced sample size.

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Antiretroviral Therapy during Pregnancy and the Risk of an Adverse Outcome

Cited by 338 publications

References 22 publications

HIV Pregnant Women WItH more tHan one Pregnancy and tHe Use of antIretroVIral dUrIng Pre-natal care and cHIldbIrtH

HIV Pregnant Women WItH more tHan one Pregnancy and tHe Use of antIretroVIral dUrIng Pre-natal care and cHIldbIrtH

Association between in utero zidovudine exposure and nondefect adverse birth outcomes: analysis of prospectively collected data from the Antiretroviral Pregnancy Registry

Mitochondrial toxicity and caspase activation in HIV pregnant women

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