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Timing of antiretroviral therapy and adverse pregnancy outcomes : a systematic review and meta-analysis
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Uthman, Olalekan A., Nachega , Jean B., Anderson, Jean, Kanters, Steve, Mills, Edward J., Renaud, Francoise, Essajee, Shaffiq, Doherty, Meg C. and Mofenson, Lynne M. (2017) Timing of antiretroviral therapy and adverse pregnancy outcomes : a systematic review and meta-analysis. Lancet HIV, 4 (1). e21-e30. doi:10.1016/S2352-3018(16)30195-3 ISSN 2352-3018.
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Official URL: http://dx.doi.org/10.1016/S2352-3018(16)30195-3
Abstract
BACKGROUND: Although life-long combination antiretroviral therapy (ART) is recommended for all HIV-infected individuals, there are limited data on pregnancy outcome with ART initiation pre-conception. We assessed the safety of ART initiated pre-conception versus post-conception on adverse pregnancy outcome.
METHODS: We conducted a systematic review of studies from low-, middle-, and high-income countries. We searched Cochrane Central Register of Controlled Trials, EMBASE, LILACS, MEDLINE for randomized trials, quasi-randomized trials and prospective cohort studies conducted between 01 January 1980 to 01 June 2016). Risk ratios were pooled using a random-effects model.
FINDINGS: Eleven studies were included (N=19,189 mother-infant pairs). Women initiating ART pre-conception compared to post-conception were significantly more likely to deliver preterm (pooled risk ratio[RR]=1·20, 95% confidence interval[CI] 1·01-1·14, 10 studies), very preterm (RR=1·53, 95%CI 1·22-1·92, two studies), or have low birth weight (LBW) infants (RR=1·30, 95%CI 1·04-1·62, two studies). Data on neonatal mortality was limited. We found no increase in very LBW (RR=0.18, 95% CI 0.02-1.51, one study), small for gestational age (SGA) (RR = 1·13, 95% CI 0·94-1·35, two studies), severe SGA (RR=1·09, 95%CI 0·82-1·45, one study), stillbirth (RR= RR=1·30, 95% CI 0·99-1·69, two studies) or congenital anomalies (RR= RR=1·24, 95% CI 0·61-2·49, one study).
INTERPRETATION: The benefits of ART for maternal health and prevention of perinatal transmission outweigh risks, but there remain limited, poor quality data on the extent/severity of these risks. We found elevated preterm delivery and low birth weight rates associated with pre-conception ART. As pre-conception ART rapidly increases globally, it will be critical to monitor for potential adverse pregnancy outcomes.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > RC Internal medicine R Medicine > RG Gynecology and obstetrics |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||||
Library of Congress Subject Headings (LCSH): | Pregnancy, Antiretroviral agents, Systematic reviews (Medical research) | ||||||||
Journal or Publication Title: | Lancet HIV | ||||||||
Publisher: | The Lancet Publishing Group | ||||||||
ISSN: | 2352-3018 | ||||||||
Official Date: | January 2017 | ||||||||
Dates: |
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Volume: | 4 | ||||||||
Number: | 1 | ||||||||
Page Range: | e21-e30 | ||||||||
DOI: | 10.1016/S2352-3018(16)30195-3 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||||
Date of first compliant deposit: | 5 September 2016 | ||||||||
Date of first compliant Open Access: | 17 May 2017 | ||||||||
Funder: | World Health Organization (WHO) |
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