The Effect of Antiretroviral Therapy for the Treatment of Human Immunodeficiency Virus (HIV)-1 in Pregnancy on Gestational Weight Gain.

Background: Gestational weight gain above Institute of Medicine recommendations is associated with increased risk of pregnancy complications. The goal was to analyze the association between newer HIV antiretroviral regimens (ART) on gestational weight gain.
Methods: A retrospective cohort study of pregnant women with HIV-1 on ART. The primary outcome was incidence of excess gestational weight gain. Treatment effects were estimated by ART regimen type using log-linear models for relative risk (RR), adjusting for prepregnancy BMI and presence of detectable viral load at baseline.
Results: Three hundred three pregnant women were included in the analysis. Baseline characteristics, including prepregnancy BMI, viral load at prenatal care entry, and gestational age at delivery were similar by ART, including 53% of the entire cohort had initiated ART before pregnancy (P = nonsignificant). Excess gestational weight gain occurred in 29% of the cohort. Compared with non-integrase strand transfer inhibitor (-INSTI) or tenofovir alafenamide fumarate (TAF)-exposed persons, receipt of INSTI+TAF showed a 1.7-fold increased RR of excess gestational weight gain (95% CI: 1.18-2.68; P < .01), while women who received tenofovir disoproxil fumarate had a 0.64-fold decreased RR (95% CI: .41-.99; P = .047) of excess gestational weight gain. INSTI alone was not significantly associated with excess weight gain in this population. The effect of TAF without INSTI could not be inferred from our data. There was no difference in neonatal, obstetric, or maternal outcomes between the groups.
Conclusions: Pregnant women receiving ART with a combined regimen of INSTI and TAF have increased risk of excess gestational weight gain.
Competing Interests: Potential conflicts of interest. M. L. B. reports the following contracts/support: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Pediatric and Adolescent HIV/AIDS research program at Emory University School of Medicine–International Maternal Pediatric Adolescent AIDS Clinical Trial (IMPAACT) Network site co-investigator; National Institutes of Health (NIH), Emory Vaccine and Treatment Evaluation Unit—DMID 21-004-MOMI-Vax: An Observational, Prospective Cohort Study of the Immunogenicity and Safety of SARS-CoV-2 Vaccines Administered during Pregnancy or Postpartum and Evaluation of Antibody Transfer and Durability in Infants (3UM1AI148576-02S5, site principal investigator); NIH/Mental Health (MH)—The Effects of Pregnancy on Post Traumatic Symptoms and Fear Physiology in Traumatized African American Women–Impacts of COVID-19 and Racial Discrimination on Mental, Physical, and Psychophysiological Health in Black Pregnant and Postpartum Persons (3R01MH115174-04W1, site co-investigator). G. A. S. and N. T. J. report royalties for the following UpToDate articles: “Disaster Settings: Care of Pregnant People,” and “Disaster Settings: Care of Gynecologic Problems.” All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
(© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)