Small-for-Gestational-Age Births in Pregnant Women with HIV, due to Severity of HIV Disease, Not Antiretroviral Therapy

Aaron, Erika; Bonacquisti, Alexa; Mathew, Lazar; Alleyne, Gregg; Bamford, Laura; Culhane, Jennifer F.

doi:10.1155/2012/135030

Cited by 29 publications

(47 citation statements)

References 29 publications

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“…Similarly, it was noted that having an index pregnancy that did not result in a live birth was an important predictor of having a repeat pregnancy. This finding was previously described (Suryavanshi et al, 2008) and it is important to note that adverse birth outcomes occur more frequently in HIV-infected women than in those without HIV (Aaron et al, 2012; Ekouevi et al, 2008; Kupka et al, 2009; Paiva et al, 2007; Young et al, 2012). …”

Section: Discussionsupporting

confidence: 83%

Repeat pregnancy in women with HIV infection in Latin America and the Caribbean

et al. 2015

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Intended and unintended pregnancies occur frequently among HIV-infected women. We evaluated the occurrence of repeat pregnancy and characteristics associated with this outcome among HIV-infected women in Latin America and the Caribbean who were participating in the National Institute of Child Health and Human Development (NICHD) International Site Development Initiative (NISDI). Of the 1342 HIV-infected pregnant women enrolled in NISDI, 124 (9.2%) had one or more repeat pregnancies on study. Median time between the index delivery and date of conception of the subsequent pregnancy was 1.4 years (range 0.1–5.7). Younger age [odds ratio (OR)=1.07, 95% confidence interval (CI): 1.04–1.11 per one-year decrease in age], hospitalization during the index pregnancy or up to 6 months postpartum [OR=2.0, 95% CI: 1.2–3.4], and poor index pregnancy outcome (stillbirth or spontaneous/therapeutic abortion) [OR=3.4, 95% CI: 1.4–8.4] were associated with increased occurrence of repeat pregnancy in multivariable analysis. Among women with repeat pregnancies, the proportion receiving antiretroviral treatment (versus prophylaxis) increased from 39.4% at the time of the index pregnancy to 81.8% at the time of the repeat pregnancy (p<0.001). These results can help identify women most likely to benefit from reproductive counseling in order to assist with healthy pregnancy planning and prevention of unintended pregnancies.

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Section: Discussionsupporting

confidence: 83%

Repeat pregnancy in women with HIV infection in Latin America and the Caribbean

et al. 2015

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“…The literature has reported a dose-dependent association between smoking and SGA, PT and SB. (1, 35, 36) Smoking during pregnancy has also been associated with poor adherence to antiretroviral medications and to lower rates of virological suppression. (37, 38) Smoking cessation interventions should be offered to pregnant women who continue to smoke.…”

Section: Discussionmentioning

confidence: 99%

Predictors of adverse pregnancy outcomes in women infected with HIV in Latin America and the Caribbean: a cohort study

Kreitchmann

Melo

et al. 2014

BJOG

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Objectives To examine maternal characteristics associated with adverse pregnancy outcomes (APOs) among HIV-infected women. Design Prospective cohort study Setting Multiple sites in Latin America and the Caribbean Population First on-study pregnancy among HIV-1-infected women enrolled in NISDI (Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) International Site Development Initiative) Perinatal (2002–2007) and LILAC (2008–2012) studies. Methods Frequencies of APOs assessed among pregnancies. Risk factors investigated by logistic regression analysis. Main Outcome measures APOs including preterm delivery (PT), low birth weight (LBW), small for gestational age (SGA), stillbirth (SB) and neonatal death. Results Among 1512 women, 1.9% (95% confidence interval [CI] 1.3–2.7%) of singleton pregnancies resulted in a stillbirth and 32.9% (30.6–35.4%) had at least one APO. Of 1483 singleton live births, 19.8% (17.8–21.9%) were PT, 14.2% (12.5–16.1%) were LBW, 12.6% (10.9–14.4%) were SGA, and 0.4% (0.2–0.9%) of infants died within 28 days after birth. Multivariable logistic regression modeling indicated that the following risk factors increased the probability of having one or more APOs: lower maternal body mass index (odds ratio [OR]=2.2; 95% CI: 1.4–3.5) at delivery, hospitalization during pregnancy (OR=3.3; 95% CI: 2.0–5.3), hypertension during pregnancy (OR=2.7; 95% CI: 1.5–4.8), antiretroviral use at conception (OR=1.4; 95% CI: 1.0–1.9) and tobacco use during pregnancy (OR=1.7; 95% CI: 1.3–2.2). Results of fitting multivariable logistic regression models for PT, LBW, SGA and SB are also reported. Conclusions HIV-infected women had relatively high occurrence of APOs and some maternal risk factors were associated with these APOs. Interventions targeting modifiable risk factors should be evaluated further.

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“…Though the earlier PACTG 076 & 185/ PACTS/WITS combined analysis demonstrated a lack of association between cART and LBW, it did find a slightly increased risk of very (V)LBW with PI-based cART (OR=3.03, 95% CI: 1.04–12.19). (28) Neither the PHACS study (32) nor a U.S. study of 183 HIV-infected pregnant women (34) revealed an association of PI-based cART with SGA. However the latter did report a small protective effect of non-nucleoside reverse transcriptase inhibitors (NNRTIs) on SGA (OR=0.28, 95% CI: 0.1–0.75).…”

Section: Intrauterine Growthmentioning

confidence: 99%

“…However the latter did report a small protective effect of non-nucleoside reverse transcriptase inhibitors (NNRTIs) on SGA (OR=0.28, 95% CI: 0.1–0.75). (34)…”

Section: Intrauterine Growthmentioning

confidence: 99%

Metabolic Complications of in utero Maternal HIV and Antiretroviral Exposure in HIV-exposed Infants

Jao

Abrams

2014

Pediatric Infectious Disease Journal

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Background Despite a wide body of literature supporting the use of antenatal antiretrovirals (ARV) for the prevention of mother to child transmission, there remains a need for continued monitoring as the intrauterine interval is a critical period during which fetal programming influences the future health and development of the child. Methods We conducted a systematic review of the current literature addressing potential metabolic complications of in utero HIV and ARV exposure. We describe studies evaluating metabolic outcomes such as intrauterine and early postnatal growth, bone health, and mitochondrial toxicity. Results Overall, infants exposed to HIV/ARV do not appear to exhibit vastly compromised intrauterine or early postnatal growth. However, some studies on the effect of combination antiretroviral therapy (cART) on small for gestational age (SGA) and low birth weight (LBW) outcomes in low-middle income countries show a risk for SGA/LBW while those in the U.S. do not. Postnatal growth to 1 year does not appear to be affected by intrauterine tenofovir exposure in African studies, but a U.S. study found statistically significant differences in length for age z scores (LAZ) at 1 year. Little data exists on long term bone health. Mitochondrial toxicity including abnormal mitochondrial morphology and DNA content, as well as neurologic deficits and death have been demonstrated in HIV/ARV–exposed infants. Conclusion Though gross measures of metabolic well-being appear to be reassuring, careful vigilance of even small risks for potential serious adverse effects to infants exposed to intrauterine HIV/ARVs is warranted as intrauterine fetal metabolic programming may substantially impact the future health of the child.

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Small-for-Gestational-Age Births in Pregnant Women with HIV, due to Severity of HIV Disease, Not Antiretroviral Therapy

Cited by 29 publications

References 29 publications

Repeat pregnancy in women with HIV infection in Latin America and the Caribbean

Repeat pregnancy in women with HIV infection in Latin America and the Caribbean

Predictors of adverse pregnancy outcomes in women infected with HIV in Latin America and the Caribbean: a cohort study

Metabolic Complications of in utero Maternal HIV and Antiretroviral Exposure in HIV-exposed Infants

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