Associations of HIV and antiretroviral therapy with gestational diabetes: findings from a prospective cohort in South Africa

Abstract

Objective: To estimate associations of HIV-status and antiretroviral (ART) regimen with gestational diabetes (GDM) and postpartum glucose metabolism. Design: Prospective cohort study Methods: We enrolled pregnant persons living with HIV(PHIV) and without HIV in Cape Town, South Africa who were ≥18 years of age at 24–28 weeks gestation and followed up to 26 months postpartum. Participants were tested for GDM in pregnancy and for diabetes postpartum using a 75 g 2-hour oral glucose tolerance test and diagnosed via WHO criteria. We estimated associations of HIV-status and ART regime (efavirenz (EFV) vs dolutegravir (DTG)) with GDM and postpartum impaired glucose metabolism using multivariable log binomial or linear regression models. Results: Among 397 participants (median age 30 (IQR 25,34; n = 198 without HIV, n = 199 PHIV), the prevalence of GDM was 6.0% (9.0 PHIV vs 3.0% without HIV). In multivariable analyses, PHIV were at higher risk of GDM (RR 3.9 95% CI 1.4, 10.7) after adjustment for pre-pregnancy BMI and other confounders. GDM risk did not differ by ART regimen (unadjusted prevalence 8.1% DTG vs 5.6% EFV, adjusted RR 1.1, 95% CI 0.2, 6.6). Few participants had diabetes, impaired glucose tolerance, or impaired fasting glucose postpartum (n = 13, 6%) with no differences by HIV or ART status. Conclusions: In a setting of universal GDM testing, PHIV had an increased risk of impaired glucose metabolism during pregnancy but not postpartum. Among PHIV, GDM risk was similar regardless of EFV or DTG use. Given concerns about DTG and weight gain, diabetes risk should continue to be monitored.

Cardiometabolic Health in Pregnancy and Postpartum: Findings From a Prospective Cohort Study in South Africa

“…Data came from the Cardiometabolic Health in Pregnancy (CAMP) study, a prospective cohort study to investigate how HIV and ART regimen influence cardiometabolic risk in the perinatal period. The details of the CAMP study have been published [ 24 ]. Briefly, we enrolled pregnant persons living with and without HIV, who were ≥18 years of age, 24–28 weeks’ gestation, and presented for antenatal care (ANC) in Gugulethu in Cape Town, South Africa, between November 2019 and June 2022.…”

“…Metabolic syndrome was defined according to Joint Interim Statement (JIS) criteria [ 38 ], with waist circumference defined based on previous work in South African women per JIS criteria [ 39 ], as ≥3 of the following: waist circumference >80 cm, triglycerides ≥1.7 mmol/L, high-density lipoprotein (HDL) cholesterol <1.3 mmol/L, elevated blood pressure (≥130 and/or ≥85), or fasting plasma glucose ≥5.6 mmol/L using laboratory values. Glucose metabolism and gestational weight gain outcomes were evaluated in separate analyses [ 24 ].…”