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. 2023 Aug;162(2):614-622.
doi: 10.1002/ijgo.14705. Epub 2023 Feb 20.

Type and timing of antiretroviral therapy during pregnancy: Impact on risk of preterm delivery and small-for-gestational age births in Canada, a retrospective cohort study

Jillian Schneidman  1 , Terry Lee  2 , Laura Sauve  3   4 , Jason Brophy  5 , Ari Bitnun  6 , Joel Singer  2   7 , Deborah Money  4   8 , Fatima Kakkar  9 , Isabelle Boucoiran  10   11 ; Canadian Perinatal HIV Surveillance Program (CPHSP)
Affiliations

Type and timing of antiretroviral therapy during pregnancy: Impact on risk of preterm delivery and small-for-gestational age births in Canada, a retrospective cohort study

Jillian Schneidman et al. Int J Gynaecol Obstet. 2023 Aug.

Abstract

Objective: To evaluate the impact of type and timing of antiretroviral therapy (ART) on the risk of preterm delivery (PTD) and small-for-gestational age (SGA) birth among pregnant women and people living with HIV in Canada.

Methods: Data for this retrospective cohort study were analyzed from the Canadian Perinatal HIV Surveillance Program from 1990 to 2020. The association between ART and risk of PTD (<37 weeks) and SGA birth (<10th percentile) was explored using mixed effects logistic regression and time-dependent Cox proportional hazards models.

Results: Overall, there were 14.9% (654 of 4379) PTD and 18.5% (732 of 3947) SGA cases. A higher risk of PTD was observed with nonnucleoside reverse transcriptase inhibitor-(adjusted hazard ratio [aHR], 1.73; P = 0.019) and boosted protease inhibitor- (aHR, 186; P = 0.007) based regimens compared with integrase strand transfer inhibitor (INSTI)-based regimens. ART initiation prior to conception was associated with a lower risk of SGA birth compared with ART initiation after conception at 1 to 14 weeks (adjusted odds ratio [aOR], 0.69; P = 0.024) and > 14 weeks (aOR, 0.70; P = 0.005).

Conclusion: INSTI-based ART regimens were associated with lower risk of PTD compared with other regimens, and ART initiation before conception was associated with a lower risk of SGA birth. These findings, with overall safety data, should be considered when providing pregnancy counseling to people living with HIV.

Keywords: Canada; HIV; antiretroviral therapy; pregnancy; preterm delivery; small for gestational age birth.

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