Background. Adverse pregnancy outcomes such as preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA) remain major global problems. We compared pregnancy outcomes among HIV-infected women receiving antiretroviral treatment (ART) and with CD4 ≥350 cells, and HIV-uninfected women to assess if disparities associated with HIV infection have been eliminated through use of ART. Setting: Observational study conducted at five health facilities in Blantyre, Malawi during 2016–2017. Methods. HIV-infected women receiving the national ART regimen (efavirenz+lamuvidine+tenfovir) and HIV-uninfected women were consented and enrolled at delivery. Data collected included sociodemographic and clinical; gestational age (GA); birth weight (BW); infant/maternal anthropometry; and laboratory results. We defined PTB as GA<37 weeks; LBW as BW <2·5 kg; and SGA as BW <10th percentile of GA. SGA infants were classified into proportionate and disproportionate based on ponderal index. Descriptive, stratified and multivariate logistic and linear regression analyses were used. Results. Of 5423 women approached, 614 HIV-infected and 685 HIV-uninfected women were enrolled. Rates of PTB, LBW and SGA were 10·6%, 7·2% and 17·1% among HIV-infected women on ART and 9·5%, 5·0%, and 18·4% among HIV-uninfected women, respectively. None of these differences were statistically significant in univariate or multivariate adjusted analyses (P>0·05). Of 231 SGA infants, 78·8% were proportionate and 21% were disproportionate. Of the 614 HIV-infected women on ART, 75% had undetectable virus at delivery. Conclusion. ART use has reduced the high rates of adverse pregnancy outcomes among HIV-infected women. However, the rates remain high irrespective of HIV infection and require appropriate interventions.

Objective:To determine time from delivery to resumption of sexual activity and menses among HIV-infected women on antiretroviral treatment (ART) and HIV-uninfected women. Methods:HIV-infected women on ART and HIV-uninfected women were recruited from five health facilities at delivery and followed prospectively for a maximum of 1 year in Blantyre, Malawi from January 2016 to September 2017. Sociodemographic, clinical, and laboratory data were collected at delivery and 1.5, 3, 6, 9, and 12 months. Descriptive, time to event Kaplan-Meier, and multivariable Cox proportional hazards analyses were conducted. Results: Data on 878 women (460 [52.4%] HIV-uninfected and 418 [47.6%] HIVinfected, P=0.156) who attended at least one follow-up visit were analyzed. AmongHIV-uninfected compared to HIV-infected women, respectively, the median number of days to resumption of sexual activity was 180 vs 181; to irregular menses was 82 vs 71; and to regular menses was 245 vs 366. In multivariable models, being married was associated with early resumption of sexual activity (hazard ratio [HR] 1.91, P<0.001), and being HIV-infected and use of an effective method of family planning were associated with later start of regular menses (HR<1.0, P<0.050). Conclusion: Counseling of women on reproductive intentions should start early irrespective of HIV infection or use of ART. K E Y W O R D S Africa; Antiretroviral treatment; Effective contraceptive methods; HIV; Malawi; Menses; Reproductive intentions; Resumption of sexual activity SUPPORTING INFORMATION Additional supporting information may be found online in the Supporting Information section at the end of the article. File S1. Enrollment Form. File S2. Mother Follow-up Form.