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Birth outcomes in South African women receiving highly active antiretroviral therapy : a retrospective observational study

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Abstract
Background: Use of highly active antiretroviral therapy (HAART), a triple-drug combination, in HIV-infected pregnant women markedly reduces mother to child transmission of HIV and decreases maternal morbidity. However, there remains uncertainty about the effects of in utero exposure to HAART on foetal development. Methods: Our objectives were to investigate whether in utero exposure to HAART is associated with low birth weight and/or preterm birth in a population of South African women with advanced HIV disease. A retrospective observational study was performed on women with CD4 counts <= 250 cells/mm(3) attending antenatal antiretroviral clinics in Johannesburg between October 2004 and March 2007. Low birth weight (<2.5 kg) and preterm birth rates (<37 weeks) were compared between those exposed and unexposed to HAART during pregnancy. Effects of different HAART regimen and duration were assessed. Results: Among HAART-unexposed infants, 27% (60/224) were low birth weight compared with 23% (90/388) of early HAART-exposed (exposed <28 weeks gestation) and 19% (76/407) of late HAART-exposed (exposed >= 28 weeks) infants (p = 0.05). In the early HAART group, a higher CD4 cell count was protective against low birth weight (AOR 0.57 per 50 cells/mm(3) increase, 95% CI 0.45-0.71, p < 0.001) and preterm birth (AOR 0.68 per 50 cells/mm3 increase, 95% CI 0.55-0.85, p = 0.001). HAART exposure was associated with an increased preterm birth rate (15%, or 138 of 946, versus 5%, or seven of 147, in unexposed infants, p = 0.001), with early nevirapine and efavirenz-based regimens having the strongest associations with preterm birth (AOR 5.4, 95% CI 2.1-13.7, p < 0.001, and AOR 5.6, 95% CI 2.1-15.2, p = 0.001, respectively). Conclusions: In this immunocompromised cohort, in utero HAART exposure was not associated with low birth weight. An association between NNRTI-based HAART and preterm birth was detected, but residual confounding is plausible. More advanced immunosuppression was a risk factor for low birth weight and preterm birth, highlighting the importance of earlier HAART initiation in women to optimize maternal health and improve infant outcomes.
Keywords
INCREASED RISK, PREGNANCY OUTCOMES, TRANSMISSION, METAANALYSIS, ASSOCIATION, INFANTS, HIV-1-INFECTED WOMEN, PREMATURE DELIVERY, PRETERM BIRTH, HIV-INFECTED WOMEN

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Chicago
van der Merwe, Karin, Risa Hoffman, Vivian Black, Matthew Chersich, Ashraf Coovadia, and Helen Rees. 2011. “Birth Outcomes in South African Women Receiving Highly Active Antiretroviral Therapy : a Retrospective Observational Study.” Journal of the International Aids Society 14.
APA
van der Merwe, Karin, Hoffman, R., Black, V., Chersich, M., Coovadia, A., & Rees, H. (2011). Birth outcomes in South African women receiving highly active antiretroviral therapy : a retrospective observational study. JOURNAL OF THE INTERNATIONAL AIDS SOCIETY, 14.
Vancouver
1.
van der Merwe K, Hoffman R, Black V, Chersich M, Coovadia A, Rees H. Birth outcomes in South African women receiving highly active antiretroviral therapy : a retrospective observational study. JOURNAL OF THE INTERNATIONAL AIDS SOCIETY. 2011;14.
MLA
van der Merwe, Karin, Risa Hoffman, Vivian Black, et al. “Birth Outcomes in South African Women Receiving Highly Active Antiretroviral Therapy : a Retrospective Observational Study.” JOURNAL OF THE INTERNATIONAL AIDS SOCIETY 14 (2011): n. pag. Print.
@article{2055181,
  abstract     = {Background: Use of highly active antiretroviral therapy (HAART), a triple-drug combination, in HIV-infected pregnant women markedly reduces mother to child transmission of HIV and decreases maternal morbidity. However, there remains uncertainty about the effects of in utero exposure to HAART on foetal development. 
Methods: Our objectives were to investigate whether in utero exposure to HAART is associated with low birth weight and/or preterm birth in a population of South African women with advanced HIV disease. A retrospective observational study was performed on women with CD4 counts {\textlangle}= 250 cells/mm(3) attending antenatal antiretroviral clinics in Johannesburg between October 2004 and March 2007. Low birth weight ({\textlangle}2.5 kg) and preterm birth rates ({\textlangle}37 weeks) were compared between those exposed and unexposed to HAART during pregnancy. Effects of different HAART regimen and duration were assessed. 
Results: Among HAART-unexposed infants, 27\% (60/224) were low birth weight compared with 23\% (90/388) of early HAART-exposed (exposed {\textlangle}28 weeks gestation) and 19\% (76/407) of late HAART-exposed (exposed {\textrangle}= 28 weeks) infants (p = 0.05). In the early HAART group, a higher CD4 cell count was protective against low birth weight (AOR 0.57 per 50 cells/mm(3) increase, 95\% CI 0.45-0.71, p {\textlangle} 0.001) and preterm birth (AOR 0.68 per 50 cells/mm3 increase, 95\% CI 0.55-0.85, p = 0.001). HAART exposure was associated with an increased preterm birth rate (15\%, or 138 of 946, versus 5\%, or seven of 147, in unexposed infants, p = 0.001), with early nevirapine and efavirenz-based regimens having the strongest associations with preterm birth (AOR 5.4, 95\% CI 2.1-13.7, p {\textlangle} 0.001, and AOR 5.6, 95\% CI 2.1-15.2, p = 0.001, respectively). 
Conclusions: In this immunocompromised cohort, in utero HAART exposure was not associated with low birth weight. An association between NNRTI-based HAART and preterm birth was detected, but residual confounding is plausible. More advanced immunosuppression was a risk factor for low birth weight and preterm birth, highlighting the importance of earlier HAART initiation in women to optimize maternal health and improve infant outcomes.},
  articleno    = {42},
  author       = {van der Merwe, Karin and Hoffman, Risa and Black, Vivian and Chersich, Matthew and Coovadia, Ashraf and Rees, Helen},
  issn         = {1758-2652},
  journal      = {JOURNAL OF THE INTERNATIONAL AIDS SOCIETY},
  keyword      = {INCREASED RISK,PREGNANCY OUTCOMES,TRANSMISSION,METAANALYSIS,ASSOCIATION,INFANTS,HIV-1-INFECTED WOMEN,PREMATURE DELIVERY,PRETERM BIRTH,HIV-INFECTED WOMEN},
  language     = {eng},
  pages        = {11},
  title        = {Birth outcomes in South African women receiving highly active antiretroviral therapy : a retrospective observational study},
  url          = {http://dx.doi.org/10.1186/1758-2652-14-42},
  volume       = {14},
  year         = {2011},
}

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