An essential component of working in the maternal and neonatal health field is staying up to date on the rapidly evolving research. We do this through a variety of outlets; social media is a vital tool, and press releases or news stories are always useful sources. Another way for us to stay informed is by attending talks by experts in the field. This is how we found out about recent research on the adverse birth outcomes of ARV use during pregnancy.
ARV use during pregnancy has been proven again and again to be an efficient method for prevention of mother-to-child transmission (PMTCT) of HIV. In fact, proper ARV treatment throughout the stages of pregnancy, labor, delivery, and breastfeeding decreases the risk of transmission from as high as 45% to below 5%. In the presence of such evidence, the WHO now recommends providing lifelong Highly Active Antiretroviral Therapy (HAART) to all pregnant women regardless of CD4 count. However, evidence has begun to surface regarding the adverse effects of this life-saving treatment.
A number of recent studies have been conducted to examine the effects of ARV treatment on pregnancy. The results have been mixed. Most of the studies have been done in developed countries or with very small sample sizes, so their results cannot necessarily be extended to the populations where we at Maternova are most involved with PMTCT. This aside, two recent studies conducted in Botswana and Tanzania have found a correlation between HAART during pregnancy and adverse birth outcomes. The adverse birth outcomes considered here were preterm birth, stillbirths, small size for gestational age, and neonatal death. The studies of interest are cited below.
With this new evidence in mind, it is important to continue monitoring the effects of ARV treatment on birth outcomes. ARV therapy has been largely responsible for the decline in mother-to-child transmission of HIV in recent years, so much more research is required before any changes to the guidelines for ARV treatments are made. That being said, we will continue to monitor research and studies on ARV treatment to stay up to date on the safest regimen for mothers while still preventing mother-to-child transmission.
By Hugo Petijean
Works Cited: Chen, J. Y., H. J. Ribaudo, S. Souda, N. Parekh, A. Ogwu, S. Lockman, K. Powis, S. Dryden-Peterson, T. Creek, W. Jimbo, T. Madidimalo, J. Makhema, M. Essex, and R. L. Shapiro. "Highly Active Antiretroviral Therapy and Adverse Birth Outcomes Among HIV-Infected Women in Botswana." Journal of Infectious Diseases 206.11 (2012): 1695-705. Print.
Li, Nan, Mary Mwanyika Sando, Donna Spiegelman, Ellen Hertzmark, Enju Liu, David Sando, Lameck Machumi, Guerino Chalamilla, and Wafaie Fawzi. "Antiretroviral Therapy in Relation to Birth Outcomes among HIV-infected Women: A Cohort Study." Journal of Infectious Diseases J Infect Dis. 213.7 (2015): 1057-064. Print.
Identification of anemia in pregnant women is important, since it is an important cause of multiple complications during pregnancy (preterm delivery, low birth weight and perinatal death), so it is recommended to all pregnant women, in the first prenatal visit and at 28 weeks of gestation, the measurement of serum concentrations of hemoglobin and hematocrit as a screening test for anemia.
Prenatal assessment seeks to identify, through clinical history, sociodemographic characteristics, mean blood pressure, Doppler of the uterine arteries and biochemical markers such as pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PlGF), those women who are at high risk of developing preeclampsia in order to take appropriate measures. that can help reduce that risk.