Timing of initiation of antiretroviral therapy and adverse pregnancy outcomes: a systematic review and meta-analysis

Olalekan A. Uthman, Jean B. Nachega, Jean Anderson, Steve Kanters, Edward J. Mills, Françoise Renaud, Shaffiq Essajee, Meg Caroline Doherty, Lynne M. Mofenson

Research output: Contribution to journalArticle

Abstract

Background Although lifelong combination antiretroviral therapy (ART) is recommended for all individuals with HIV, few data exist for pregnancy outcomes associated with ART initiation before conception. We assessed adverse pregnancy outcomes associated with ART initiated before conception compared with that of ART started after conception. Methods We did a systematic review of studies from low-income, middle-income, and high-income countries by searching the Cochrane Central Register of Controlled Trials, Embase, LILACS, MEDLINE, Toxline, Web of Knowledge, and WHO Global Index Medicus and trials in progress (International Clinical Trials Registry Platform) for randomised trials, quasi-randomised trials, and prospective cohort studies done between Jan 1, 1980, and June 1, 2016, in which timing of ART initiation in pregnant women living with HIV was reported. We used the risk ratio (RR) and corresponding 95% CIs as the primary measure to assess the association between the selected outcomes and ART initiation before conception versus after conception. We used a random-effects model to pool risk ratios. Findings We included 11 studies with 19 189 mother–infant pairs. Women who started ART before conception were significantly more likely to deliver preterm (pooled RR 1·20, 95% CI 1·01−1·44) or very preterm (1·53, 1·22−1·92), or to have low-birthweight infants (1·30, 1·04−1·62) than were those who began ART after conception. Few data exist for neonatal mortality. The risk of very low birthweight, small for gestational age, severe small for gestational age, stillbirth, and congenital anomalies did not differ significantly between women who were taking ART before conception and those who began ART after conception. Interpretation The benefits of ART for maternal health and prevention of perinatal transmission outweigh risks, but data for the extent and severity of these risks are scarce and of low quality. As use of ART before conception rapidly increases globally, monitoring for potential adverse pregnancy outcomes will be crucial. Funding WHO.

Original languageEnglish (US)
Pages (from-to)e21-e30
JournalThe Lancet HIV
Volume4
Issue number1
DOIs
StatePublished - Jan 1 2017

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Pregnancy Outcome
Meta-Analysis
Therapeutics
Odds Ratio
MEDLINE
Gestational Age
HIV
Stillbirth
Infant Mortality
Registries
Pregnant Women
Cohort Studies
Clinical Trials
Prospective Studies

ASJC Scopus subject areas

  • Epidemiology
  • Immunology
  • Infectious Diseases
  • Virology

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Timing of initiation of antiretroviral therapy and adverse pregnancy outcomes : a systematic review and meta-analysis. / Uthman, Olalekan A.; Nachega, Jean B.; Anderson, Jean; Kanters, Steve; Mills, Edward J.; Renaud, Françoise; Essajee, Shaffiq; Doherty, Meg Caroline; Mofenson, Lynne M.

In: The Lancet HIV, Vol. 4, No. 1, 01.01.2017, p. e21-e30.

Research output: Contribution to journalArticle

Uthman, Olalekan A. ; Nachega, Jean B. ; Anderson, Jean ; Kanters, Steve ; Mills, Edward J. ; Renaud, Françoise ; Essajee, Shaffiq ; Doherty, Meg Caroline ; Mofenson, Lynne M. / Timing of initiation of antiretroviral therapy and adverse pregnancy outcomes : a systematic review and meta-analysis. In: The Lancet HIV. 2017 ; Vol. 4, No. 1. pp. e21-e30.
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