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

Vannappagari, Vani; Koram, Nana; Albano, Jessica D.; Tilson, Hugh H.; Gee, Conway

doi:10.1111/1471-0528.13542

Cited by 9 publications

(5 citation statements)

References 16 publications

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“…In a meta-analysis (35 studies: 20 prospective cohorts, 12 retrospective cohorts, three case-control studies), HIV infection in women not receiving ART was clearly associated with preterm birth, low birthweight, small for gestational age (SGA), and stillbirth, especially in sub-Saharan Africa (10). Recent data on prevalence of congenital abnormalities in HEU children, and associations with in utero ART exposure are presented in Table 1, which are consistent with the literature to date, indicating a similar risk of defects as in the general population (11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Section: Adverse Pregnancy Outcomes Congenital Abnormalities Cardiasupporting

confidence: 83%

Health and survival of HIV perinatally exposed but uninfected children born to HIV-infected mothers

Desmonde

Goetghebuer

Thorne

et al. 2016

Current Opinion in HIV and AIDS

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Section: Adverse Pregnancy Outcomes Congenital Abnormalities Cardiasupporting

confidence: 83%

Health and survival of HIV perinatally exposed but uninfected children born to HIV-infected mothers

Desmonde

Goetghebuer

Thorne

et al. 2016

Current Opinion in HIV and AIDS

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“…Low birth weight and preterm birth were more frequent in the combined ART group compared to AZT monotherapy [ 29 ]. Data from the American Antiretroviral Pregnancy Registry from 1989 to 2013 also found an increased risk for low birth weight among patients utilizing AZT regimens [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Adverse effects in children exposed to maternal HIV and antiretroviral therapy during pregnancy in Brazil: a cohort study

et al. 2018

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BackgroundAntiretroviral therapy (ART) in pregnancy was associated with a drastic reduction in HIV mother-to-child transmission (MTCT), although it was associated with neonatal adverse effects. The aim of this study was to evaluate the neonatal effects to maternal ART.MethodsThis study was a cohort of newborns from HIV pregnant women followed at the CAISM/UNICAMP Obstetric Clinic from 2000 to 2015. The following adverse effects were evaluated: anemia, thrombocytopenia, liver function tests abnormalities, preterm birth, low birth weight and congenital malformation. Data collected from patients’ files was added to a specific database. Descriptive analysis was shown in terms of absolute (n) and relative (%) frequencies and mean, median and standard deviation calculations. The association between variables was tested through Chi-square or Fisher exact test (n < 5) and relative risk (RR) with its respective p values for the categorical ones and t-Student (parametric data) or Mann-Whitney (non-parametric data) for the quantitative ones. The significant level used was 0.05. A multivariate Cox Logistic Regression was done. Statistical analysis was performed using SAS version 9.4.ResultsData from 787 newborns was analyzed. MTCT rate was 2.3%, with 0.8% in the last 5 years. Observed neonatal adverse effects were: liver function tests abnormalities (36%), anemia (25.7%), low birth weight (22.5%), preterm birth (21.7%), children small for gestational age (SGA) (18%), birth defects (10%) and thrombocytopenia (3.6%). In the multivariate analysis, peripartum CD4 higher than 200 cells/mm3 was protective for low birth weight and preterm birth, and C-section was associated with low birth weight, but not with preterm birth. Neonatal anemia was associated with preterm birth and exposure to maternal AZT. Liver function tests abnormalities were associated with detectable peripartum maternal viral load and exposure to nevirapine. No association was found between different ART regimens or timing of exposure with preterm birth, low birth weight or congenital malformation.ConclusionHighly active antiretroviral treatment in pregnant women and viral load control were the main factors associated with MTCT reduction. Antiretroviral use is associated with a high frequency but mainly low severity adverse effects in newborns.

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“…A review of studies published between 1980 and 2017 compared women receiving tenofovir vs nontenofovir cART regimens during pregnancy and found no increased miscarriage risk, 47 and a study of zidovudine vs nonzidovudine cART regimens found a protective effect for miscarriage. 48 Meanwhile, PIs may lower progesterone levels, 49 possibly leading to adverse pregnancy outcomes including miscarriage, 50 preterm birth, 19 and lower birthweight. 20 History of miscarriage was not associated with miscarriage in our adjusted models.…”

Section: Figurementioning

confidence: 99%

Miscarriage among women in the United States Women’s Interagency HIV Study, 1994–2017

Wall

Haddad

Mehta

et al. 2019

American Journal of Obstetrics and Gynecology

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BACKGROUND: Relatively little is known about the frequency and factors associated with miscarriage among women living with HIV. OBJECTIVE: The objective of the study was to evaluate factors associated with miscarriage among women enrolled in the Women's Interagency HIV Study. STUDY DESIGN: We conducted an analysis of longitudinal data collected from Oct. 1, 1994, to Sept. 30, 2017 Women who attended at least 2 Women's Interagency HIV Study visits and reported pregnancy during follow-up were included. Miscarriage was defined as spontaneous loss of pregnancy before 20 weeks of gestation based on self-report assessed at biannual visits. We modeled the association between demographic, behavioral, and clinical covariates and miscarriage (vs live birth) for women overall and stratified by HIV status using mixed-model logistic regression. RESULTS: Similar proportions of women living with and without HIV experienced miscarriage (37% and 39%, respectively, P ¼ .638). In adjusted analyses, smoking tobacco (adjusted odds ratio, 2.0), alcohol use (adjusted odds ratio, 4.0), and marijuana use (adjusted odds ratio, 2.0) were associated with miscarriage. Among women living with HIV, low HIV viral load (<4 log10 copies/mL) (adjusted odds ratio, 0.5) and protease inhibitor (adjusted odds ratio, 0.4) vs the nonuse of combination antiretroviral therapy use were protective against miscarriage. CONCLUSION: We did not find an increased odds of miscarriage among women living with HIV compared with uninfected women; however, poorly controlled HIV infection was associated with increased miscarriage risk. Higher miscarriage risk among women exposed to tobacco, alcohol, and marijuana highlight potentially modifiable behaviors. Given previous concern about antiretroviral therapy and adverse pregnancy outcomes, the novel protective association between protease inhibitors compared with nonecombination antiretroviral therapy and miscarriage in this study is reassuring.

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

Cited by 9 publications

References 16 publications

Health and survival of HIV perinatally exposed but uninfected children born to HIV-infected mothers

Health and survival of HIV perinatally exposed but uninfected children born to HIV-infected mothers

Adverse effects in children exposed to maternal HIV and antiretroviral therapy during pregnancy in Brazil: a cohort study

Miscarriage among women in the United States Women’s Interagency HIV Study, 1994–2017

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