Grosch-Woerner I, Puch K, Maier R F, Niehues T, Notheis G, Patel D, Casteleyn S, Feiterna-Sperling C, Groeger S, Zaknun D
Department of General Paediatrics, Charité Universitaetsmedizin Berlin, Berlin, Germany.
HIV Med. 2008 Jan;9(1):6-13. doi: 10.1111/j.1468-1293.2008.00520.x.
The aim of the study was to assess the risk of adverse pregnancy outcomes after antenatal antiretroviral therapy in a well-defined prospective cohort of nontransmitting HIV-infected women.
Prospective monitoring of 183 mother-child pairs from 13 centres in Germany and Austria, delivering between 1995 and 2001, was carried out. Following German-Austrian guidelines recommending an elective Caesarean section (CS) at 36 weeks, prematurity was defined as <36 weeks' gestation for these analyses.
Of 183 mother-child pairs, 42% were exposed to antenatal monotherapy and 17% to dual therapy. Of the 75 women exposed to highly active antiretroviral therapy (HAART), 21 (28%) received protease inhibitor (PI)-based HAART and the remaining 54 received nonnucleoside reverse transcriptase inhibitor-based HAART. In multivariable analysis (176 pregnancies), PI-based HAART exposure during pregnancy was associated with an increased risk of premature delivery [adjusted odds ratio 3.40; 95% confidence interval (CI) 1.13-10.2; P=0.029, compared with monotherapy]. Congenital abnormalities affected 3.3% infants. Perinatally, 18.9% of children (34 of 179) had respiratory problems requiring interventions, which were associated with prematurity but not with type of treatment exposure. From adjusted regression analysis, the mean birth weight z-score for children exposed to HAART with PI (+0.46; 95% CI 0.01-0.92; P=0.047) or dual therapy (+0.43; 95% CI 0.03-0.82; P=0.034) was slightly but significantly higher than that for those exposed to monotherapy; head circumference was appropriate for gestational age and there were no significant differences between treatment groups.
Use of antenatal PI-based HAART initiated before or during pregnancy was associated with a significantly increased risk of premature delivery at <36 weeks' gestation. The overall crude prematurity rate was 34% (63 of 183; 95% CI 28-42).
本研究旨在评估在一个明确界定的未传播HIV感染女性前瞻性队列中，产前抗逆转录病毒治疗后不良妊娠结局的风险。
对1995年至2001年间在德国和奥地利13个中心分娩的183对母婴进行前瞻性监测。遵循德国-奥地利指南，建议在36周时选择性剖宫产（CS），在这些分析中，早产定义为孕周<36周。
在183对母婴中，42%接受了产前单一疗法，17%接受了联合疗法。在75名接受高效抗逆转录病毒治疗（HAART）的女性中，21名（28%）接受了基于蛋白酶抑制剂（PI）的HAART，其余54名接受了基于非核苷类逆转录酶抑制剂的HAART。在多变量分析（176例妊娠）中，孕期暴露于基于PI的HAART与早产风险增加相关[调整后的优势比3.40；95%置信区间（CI）1.13 - 10.2；P = 0.029，与单一疗法相比]。先天性异常影响了3.3%的婴儿。围产期，18.9%的儿童（179名中的34名）有需要干预的呼吸问题，这与早产相关，但与治疗暴露类型无关。经调整的回归分析显示，暴露于含PI的HAART（+0.46；95% CI 0.01 - 0.92；P = 0.047）或联合疗法（+0.43；95% CI 0.03 - 0.82；P = 0.034）的儿童的平均出生体重z评分略高于但显著高于暴露于单一疗法的儿童；头围与孕周相符，治疗组之间无显著差异。
在妊娠前或妊娠期间开始使用基于产前PI的HAART与孕周<36周时早产风险显著增加相关。总体早产粗发生率为34%（183例中的63例；95% CI 28 - 42）。
