Antiretroviral agents and acid-base balance at delivery of the neonate

Abstract

Limited evidence is available regarding antiretroviral (ARV) safety for uninfected infants exposed to these drugs in utero. Our objective was to determine if ARV administered to pregnant women is associated with decreasing umbilical arterial pH and base excess in uninfected infants. A prospective study was conducted on 57 neonates divided into three groups: ZDV group, born to mothers taking zidovudine (N = 20), triple therapy (TT) group, born to mothers taking zidovudine + lamivudine + nelfinavir (N = 25), and control group (N = 12), born to uninfected mothers. Umbilical cord blood was used to determine umbilical artery gases. A test was performed to calculate the sample by comparing means by the unpaired one-tailed t-test, with α = 0.05 and ß = 20%, indicating the need for a sample of 18 newborn infants for the study groups to detect differences higher than 20%. The control and ARV groups were similar in gestational age, birth weight, and Apgar scores. Values of pH, pCO 2 , bicarbonate, and base excess in cord arterial blood obtained at delivery from the newborns exposed to TT were 7.23, 43.2 mmHg, 19.5 mEq/L, and -8.5 nmol/L, respectively, with no significant difference compared to the control and ZDV groups. We conclude that intrauterine exposure to ARV is not associated with a pathological decrease in umbilical arterial pH or base excess. While our data are reassuring, follow-up is still limited and needs to be continued into adulthood because of the possible potential for adverse effects of triple antiretroviral agents.

Impact of maternal HIV on umbilical cord lactate measurement at delivery in a South African labor ward

“…Evidence regarding whether ART in pregnancy is associated with hyperlactemia in neonates is conflicting, although it seems that ART is unlikely to be associated with pathologic hyperlactemia . Consistent with this, El‐Beitune et al . did not find any impact of treatment on umbilical cord gas pH or base excess.…”

“…Evidence regarding whether ART in pregnancy is associated with hyperlactemia in neonates is conflicting, 15 although it seems that ART is unlikely to be associated with pathologic hyperlactemia. 16 Consistent with this, El-Beitune et al 18 did not find any impact of treatment on umbilical cord gas pH or base excess. This finding was replicated in the present study, where the vast majority of patients with known HIV infections were receiving ARV prophylaxis or HAART, and the lactate outcomes for their neonates were comparable to those of women without HIV.…”

Antiretroviral medications during pregnancy for therapy or prophylaxis

“…El-Beitune et al [33] presented a small study of cord blood gases of neonates born to mothers taking zidovudine or HAART or born to HIV-uninfected mothers. No differences in pH, PCO2, bicarbonate, or base excess were found.…”