Use of antiretroviral therapy in pregnancy and association with birth outcome among women living with HIV in Denmark: A nationwide, population-based cohort study
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Use of antiretroviral therapy in pregnancy and association with birth outcome among women living with HIV in Denmark : A nationwide, population-based cohort study. / Moseholm, Ellen; Katzenstein, Terese Lea; Pedersen, Gitte; Johansen, Isik Somuncu; Wienecke, Lisa Skyggelund; Storgaard, Merete; Obel, Niels; Weis, Nina.
I: HIV Medicine, Bind 23, Nr. 9, 2022, s. 1007-1018.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Use of antiretroviral therapy in pregnancy and association with birth outcome among women living with HIV in Denmark
T2 - A nationwide, population-based cohort study
AU - Moseholm, Ellen
AU - Katzenstein, Terese Lea
AU - Pedersen, Gitte
AU - Johansen, Isik Somuncu
AU - Wienecke, Lisa Skyggelund
AU - Storgaard, Merete
AU - Obel, Niels
AU - Weis, Nina
PY - 2022
Y1 - 2022
N2 - Objective To describe antiretroviral therapy (ART) regimens during pregnancy among women living with HIV (WLWH) in Denmark and to examine the association between ART use in pregnancy and adverse birth outcomes. Methods A population-based cohort study including all pregnancies among WLWH in Denmark between 2000 and 2019. Data were collected through national registries. Temporal trends of ART use in pregnancy were evaluated. Logistic regression models were used to examine the association of ART use in pregnancy and other risk factors with adverse birth outcomes. Results In total, 589 pregnancies were included. Combination treatment with a nucleoside reverse transcriptase inhibitor (NRTI) and a protease inhibitor (PI) was the most common ART regimen (96%). ART regimen, PI use in pregnancy and timing of ART initiation were not significantly associated with increased odds of preterm birth, small for gestational age or low birth weight. First-trimester initiation of ART was significantly associated with increased odds of intrauterine growth restriction in the multivariate analysis [adjusted odds ratio (aOR) = 3.78, 95% confidence interval (CI): 1.23-11.59], while first trimester PI use was associated with increased odds of IUGR in the univariate analysis only [OR = 3.24, 95% CI: 1.13-9.30]. Smoking, comorbidity, and maternal HIV RNA >= 50 copies/mL were independently associated with increased odds of adverse birth outcomes. Conclusions Pregnant WLWH living in Denmark are generally well treated with HIV RNA < 50 copies/mL at delivery and NRTI + PI as the most common ART regimen used in pregnancy. Initiation of ART in the first trimester may be associated with poor fetal growth. The association between ART use in pregnancy and adverse birth outcomes may partly be explained by maternal risk factors.
AB - Objective To describe antiretroviral therapy (ART) regimens during pregnancy among women living with HIV (WLWH) in Denmark and to examine the association between ART use in pregnancy and adverse birth outcomes. Methods A population-based cohort study including all pregnancies among WLWH in Denmark between 2000 and 2019. Data were collected through national registries. Temporal trends of ART use in pregnancy were evaluated. Logistic regression models were used to examine the association of ART use in pregnancy and other risk factors with adverse birth outcomes. Results In total, 589 pregnancies were included. Combination treatment with a nucleoside reverse transcriptase inhibitor (NRTI) and a protease inhibitor (PI) was the most common ART regimen (96%). ART regimen, PI use in pregnancy and timing of ART initiation were not significantly associated with increased odds of preterm birth, small for gestational age or low birth weight. First-trimester initiation of ART was significantly associated with increased odds of intrauterine growth restriction in the multivariate analysis [adjusted odds ratio (aOR) = 3.78, 95% confidence interval (CI): 1.23-11.59], while first trimester PI use was associated with increased odds of IUGR in the univariate analysis only [OR = 3.24, 95% CI: 1.13-9.30]. Smoking, comorbidity, and maternal HIV RNA >= 50 copies/mL were independently associated with increased odds of adverse birth outcomes. Conclusions Pregnant WLWH living in Denmark are generally well treated with HIV RNA < 50 copies/mL at delivery and NRTI + PI as the most common ART regimen used in pregnancy. Initiation of ART in the first trimester may be associated with poor fetal growth. The association between ART use in pregnancy and adverse birth outcomes may partly be explained by maternal risk factors.
KW - antiretroviral therapy
KW - birth outcome
KW - Danish HIV Birth Cohort
KW - pregnancy
KW - TENOFOVIR DISOPROXIL FUMARATE
KW - PRETERM DELIVERY
KW - INFECTED WOMEN
KW - SAFETY
KW - RISK
KW - EFAVIRENZ
KW - REGIMENS
KW - INFANTS
KW - SMOKING
U2 - 10.1111/hiv.13304
DO - 10.1111/hiv.13304
M3 - Journal article
C2 - 35388607
VL - 23
SP - 1007
EP - 1018
JO - HIV Medicine
JF - HIV Medicine
SN - 1464-2662
IS - 9
ER -
ID: 303572715