Pregnancy and Birth Outcomes Among Women on Antiretroviral Therapy: A Long-term Retrospective Analysis of Data from a Major Tertiary Hospital in North Central Nigeria

Abstract

Background and Objective: Antiretroviral therapy (ART) has transformed human immune deficiency virus (HIV) infection from a death sentence to a chronic syndrome, allowing infected individuals to lead near-normal lives, including achieving pregnancy and bearing children. Notwithstanding, concerns remain about the effects of ART in pregnancy. Previous studies suggested contradictory associations between ART and pregnancy. This study determined birth outcomes in pregnant women who accessed ART between 2004 and 2017 at a major tertiary hospital in North Central Nigeria. Methods: This was a retrospective study of 5,080 participants. Ethical clearance was obtained from the Institutional Review Board of the Harvard T. H. Chan School of Public Health Boston. A pro forma for data abstraction was designed and used to collect data. Abstracted data were sorted and managed using SPSS® version 22. The Chi-square test was used to calculate the proportions of pregnancy outcomes. One-way analysis of variance was used to test the effect of antiretroviral drug regimens on mean birth weight and gestational age at delivery. All levels of significance were set at p 0.05. Results: Pregnancy outcomes were recorded as live birth (99.8%), stillbirth (0.2%), preterm delivery (6.6%), and low birth weight (23%). There was a statistically significant association between ART in pregnancy and low birth weight {χ2[(5, n = 3439) = 11.99, p = 0.04]}. The highest mean birth weights were recorded in participants who received drug combinations with protease inhibitors or efavirenz, in contrast to participants who received Nevirapine, stavudine and Emtricitabine/Tenofovirbased regimens. However, there was no significant difference in the gestational age of babies at birth for the six ART regimens in the study. Conclusion and Global Health Implications: Findings support the benefits of ART in pregnancy, which is in line with the testing and treatment policies of the 90-90-90 targets for ending HIV by the year 2030. Copyright © 2021 Dapar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Association between maternal HIV infection and the risks of preterm birth and low birth weight in Chengdu, China: a propensity score matching approach

“…11 12 The findings of several previous studies indicated that maternal HIV infection could increase the risk of multiple adverse birth outcomes, incorporating preterm birth (PTB) and LBW. [7][8][9] However, other studies 10 documented no significant association, the increased risk of APOs in pregnant women living with HIV may be affected by poor socioeconomic status (older age, food insecurity and lower education level), pre-existing illnesses like anaemia and syphilis and other risk factors make HIV-exposed women more predisposed to APOs. 13 Despite the potential impact on public health, few studies have definitively assessed the relationship between HIV infection and APOs in the Asian-Pacific region.…”

“…However, the association between maternal HIV status, ART during pregnancy and pregnancy outcomes remains unclear and inconsistent across studies. [6][7][8][9][10] Preterm delivery (PTD) and low birth weight (LBW) are the major adverse pregnancy outcomes (APOs) and are associated with a range of factors, including maternal age, nutrition and socioeconomic status. However, HIV infection during pregnancy may increase the risk of these adverse outcomes, particularly if the mother does not receive ART to PMTCT.…”

“…The positive impact of PMTCT on reducing vertical transmission of HIV is widely acknowledged. However, the association between maternal HIV status, ART during pregnancy and pregnancy outcomes remains unclear and inconsistent across studies 6–10. Preterm delivery (PTD) and low birth weight (LBW) are the major adverse pregnancy outcomes (APOs) and are associated with a range of factors, including maternal age, nutrition and socioeconomic status.…”

“…Neonates with PTD and LBW suffer higher risks of perinatal morbidity and mortality and may at higher risk of poor neurodevelopmental and cardiometabolic outcomes across the life course 11 12. The findings of several previous studies indicated that maternal HIV infection could increase the risk of multiple adverse birth outcomes, incorporating preterm birth (PTB) and LBW 7–9. However, other studies10 documented no significant association, the increased risk of APOs in pregnant women living with HIV may be affected by poor socioeconomic status (older age, food insecurity and lower education level), pre-existing illnesses like anaemia and syphilis and other risk factors make HIV-exposed women more predisposed to APOs 13.…”