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Hoffman RM, Brummel S, Ziemba L, Chinula L, McCarthy K, Fairlie L, Jean-Philippe P, Chakhtoura N, Johnston B, Krotje C, Nematadzira TG, Nakayiwa F, Ndyanabangi V, Hanley S, Theron G, Violari A, João E, Correa Junior MD, Hofer CB, Navanukroh O, Aurpibul L, Nevrekar N, Zash R, Shapiro R, Stringer JSA, Currier JS, Sax P, Lockman S. Weight changes and adverse pregnancy outcomes with dolutegravir- and tenofovir alafenamide fumarate-containing antiretroviral treatment regimens during pregnancy and postpartum. Clin Infect Dis 2024:ciae001. [PMID: 38180851 DOI: 10.1093/cid/ciae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/19/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND We evaluated associations between antepartum weight change and adverse pregnancy outcomes and between antiretroviral therapy (ART) regimens and week-50 postpartum body mass index in IMPAACT 2010. METHODS Women with HIV-1 in 9 countries were randomized 1:1:1 at 14-28 weeks gestational age (GA) to start dolutegravir(DTG)+emtricitabine(FTC)/tenofovir alafenamide fumarate(TAF) versus DTG+FTC/tenofovir disoproxil fumarate(TDF) versus efavirenz (EFV)/FTC/TDF. Insufficient antepartum weight gain was defined using IOM guidelines. Cox-proportional hazards regression models were used to evaluate the association between antepartum weight change and adverse pregnancy outcomes: stillbirth (≥20 weeks GA), preterm delivery (<37 weeks GA), small for gestational age (SGA<10th percentile), and a composite of these endpoints. RESULTS 643 participants were randomized: 217 in DTG+FTC/TAF, 215 in DTG+FTC/TDF, and 211 in EFV/FTC/TDF arms. Baseline medians were: GA 21.9 weeks, HIV RNA 903 copies/mL, CD4 count 466 cells/uL. Insufficient weight gain was least frequent with DTG+FTC/TAF (15.0%) versus DTG+FTC/TDF (23.6%) and EFV/FTC/TDF (30.4%). Women in the DTG+FTC/TAF arm had the lowest rate of composite adverse pregnancy outcome. Low antepartum weight gain was associated with higher hazard of composite adverse pregnancy outcome (HR 1.44, 95%CI 1.04, 2.00) and SGA (HR 1.48, 95%CI 0.99, 2.22). More women in the DTG+FTC/TAF arm had body mass index ≥25 kg/m2 at 50 weeks postpartum (54.7%) versus the DTG+FTC/TDF (45.2%) and EFV/FTC/TDF (34.2%) arms. CONCLUSIONS Antepartum weight gain on DTG regimens was protective against adverse pregnancy outcomes traditionally associated with insufficient weight gain, supportive of guidelines recommending DTG-based ART for women starting ART during pregnancy. Interventions to mitigate postpartum weight gain are needed.
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Affiliation(s)
- Risa M Hoffman
- Dept of Medicine, University of California, Los Angeles, USA
| | | | | | | | | | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, South Africa
| | | | - Nahida Chakhtoura
- National Institute of Child Health and Human Development, National Institutes of Health, USA
| | | | | | | | | | | | - Sherika Hanley
- Centre for the AIDS Programme of Research and University of KwaZulu-Natal, Department of Family Medicine, South Africa
| | | | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwatersrand, South Africa
| | - Esau João
- Hospital Federal dos Servidores do Estado, Brazil
| | | | | | | | - Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Thailand
| | - Neetal Nevrekar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University, Pune, India
| | | | | | | | | | - Paul Sax
- Dept of Medicine, Brigham and Women's Hospital, USA
| | - Shahin Lockman
- Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, USA
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Correa Junior MD, Peraçoli JC, Costa SHM, do Nascimento MLC, Korkes HA. Letter to the editor: FIGO good practice recommendations on modifiable causes of iatrogenic preterm birth. Int J Gynaecol Obstet 2022; 159:333-334. [PMID: 35848361 DOI: 10.1002/ijgo.14345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mario Dias Correa Junior
- Department of Gynecology and Obstetrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jose Carlos Peraçoli
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, São Paulo, Brazil
| | - Sérgio Hofmeister Martins Costa
- Department of Obstetrics and Gynecology, School of Medicine, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Correa Junior MD, Santos BMRTD, Roveda JRC, Silva LCMV, Guimarães LS, Gonçalves SCL. Improving the Management of High-Risk Pregnancies with the Use of the Robson Classification. Rev Bras Ginecol Obstet 2020; 42:448-453. [PMID: 32898911 PMCID: PMC10309225 DOI: 10.1055/s-0040-1713910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To analyze the rates of cesarean delivery longitudinally in a university hospital using the Robson classification. METHODS Data related to births performed between 2014 and 2018 and recorded in the Maternal and Neonatal Health Information System (Sistema de Informações em Saúde Materna e Neonatal, SISMATER, in Portuguese) were analyzed using the Robson classification. As an aid, we used articles published in the last five years that approach the same topic in other Brazilian maternity hospitals; they were retrieved from the LILACS, MEDLINE, CINAHL, Scopus, Web of Science and Cochrane Library databases. RESULTS There was little variation in the total rate of cesarean sections in the period; however, the profile of each group changed over the years. It was possible to verify a significant reduction in the participation of groups of pregnant women with lower risk and an increase in high-risk pregnancies, attributable to the decrease in beds in the institution, with a greater transfer of patients. In addition, there was a reduction in cesarean sections among the lower-risk groups, while the rate among the higher-risk groups remained stable. CONCLUSION The use of the Robson classification to stratify cesarean deliveries contributes to a better analysis of the indications for cesarean delivery, enabling the establishment of strategies to reduce the rates, generating a positive impact on hospital management and quality of care.
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