Maternal or Infant Antiretroviral Drugs to Reduce HIV-1 Transmission

Abstract

P regnancy-induced hypertension (PIH) or pregnancyaggravated hypertension (PAH) occurs in B7% of pregnant women, but whether medical treatment for mildto-moderate gestational hypertension is necessary is controversial. Knowledge of the long-term effects of prenatal exposure to antihypertensive medications is necessary so that risks to the infant can be weighed against benefits to the mother. This historical cohort study examined the functional development of children whose mothers were treated with labetalol or methyldopa or received no antihypertensive medication (bed rest only) for mildto-moderate gestational hypertension.The children studied were born at 12 Dutch hospitals (7 teaching hospitals, 5 general hospitals) whose mothers agreed to participate in the study. The mothers of these children had received prenatally either labetalol or methyldopa, or were treated only with bed rest for gestational hypertension. Functional development was measured at ages 4 to 10 year using standard tests that assessed IQ, concentration, memory, motor development, and behavior. Linear regression and the Pearson w 2 tests were used to compare the 3 groups.A total of 4000 hospital records were reviewed, from which data on 355 mother-child pairs were extracted; 99 were treated with labetalol, 101 with methyldopa, and 155 with bed rest. Of these 355 women, 275 agreed to allow their children to participate. Ultimately, 203 children met eligibility criteria, and 202 underwent testing. Pregnancy characteristics were determined from the patients' hospital records. Compared with the medication groups, the bedrest only patients had a later onset of hypertension, more often had PIH rather than PAH, and were less likely to receive any other drugs for their disorder. Nearly 20% of women in the labetalol and methyldopa groups received phenobarbital during the pregnancy. Infants in the bed-rest group were less likely than those in the medication groups to be born very preterm, but were more likely to be small for gestational age. The groups did not differ significantly for modes of delivery and the presence of other pregnancy complications. Treatment in the methyldopa group began earlier in the pregnancy compared to women in the labetalol group, and women receiving methyldopa more frequently received other medical treatments for PIH/PAH.There was a trend towards better gross motor development for children in the labetalol and bed-rest groups compared to youngsters in the methyldopa group, but this was not statistically significant. More children in the labetalol group had attention deficit hyperactivity disorder compared to children whose mothers received methyldopa or were only on bed rest during the pregnancy. Children in the methyldopa group were more likely to have sleeping problems as reported by their parents than children in the labetalol or bed-rest groups. Other aspects of functional development were not found to differ among the three groups.In this historical cohort study, prenatal exposure to labetalol was associated with an inc...

Breastfeeding and the Use of Human Milk

“…89 Recent studies document that combining exclusive breastfeeding for 6 months with 6 months of antiretroviral therapy significantly decreases the postnatal acquisition of HIV-1. 90,91 There is no contraindication to breastfeeding for a full-term infant whose mother is seropositive for cytomegalovirus (CMV). There is a possibility that CMV acquired from mother' s milk may be associated with a late-onset sepsis-like syndrome in the extremely low birth weight (birth weight <1500 g) preterm infant.…”

Loss to Follow-Up among HIV Positive Pregnant and Lactating Mothers on Lifelong Antiretroviral Therapy for PMTCT in Rural Uganda

“…The use of combined antiretroviral therapy (ART) and elective caesarean section has reduced MTCT rates to less than 2% in non-breastfeeding populations. Among breastfeeding populations, studies have demonstrated that timely antiretroviral therapy (ART) can reduce MTCT of HIV to 5% or less [2][3][4]. In view of these studies and more in 2010, UNAIDS set a target for member states to have virtual elimination of MTCT, defined as reducing MTCT to less than 5% and 90% reduction of new HIV infections among young children by 2015 [5].…”

In-utero triple antiretroviral exposure associated with decreased growth among HIV-exposed uninfected infants in Botswana

“…The efficacy of maternal use of cART in pregnancy for PMTCT is indisputable [1][2][3][4]. However, to maximize health outcomes among HEU children we need to understand the long-term implications of in-utero cART exposure and mitigate any identified adverse consequences to the greatest extent possible.…”

“…Maternal triple antiretrovirals (cART) during pregnancy and breastfeeding are highly effective in preventing of mother-to-child HIV transmission (PMTCT) [1][2][3][4]. As a result, WHO guidelines recommend universal maternal use of triple ART (cART) during pregnancy and breastfeeding as one PMTCToption [5].…”