医疗补助计划人群中孕期抗逆转录病毒治疗的使用与小于胎龄儿出生风险
Antiretroviral Therapy Use During Pregnancy and the Risk of Small for Gestational Age Birth in a Medicaid Population.
作者信息
Phiri Kelesitse, Williams Paige L, Dugan Kate B, Fischer Michael A, Cooper William O, Seage George R, Hernandez-Diaz Sonia
机构信息
From the *Department of Epidemiology, †Department of Biostatics, Harvard School of Public Health, Boston, MA; ‡Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; §Department of Preventive Medicine, and ¶Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
出版信息
Pediatr Infect Dis J. 2015 Jul;34(7):e169-75. doi: 10.1097/INF.0000000000000712.
BACKGROUND
Several studies have assessed the association between antiretroviral (ARV) therapy use during pregnancy and small for gestational age (SGA), but the evidence remains incompletely elucidated.
METHODS
We linked data from Tennessee Medicaid files and vital records to evaluate pregnancies among human immunodeficiency virus (HIV)-infected women who delivered between 1994 and 2009. Maternal HIV status was defined based on diagnosis codes, ARV prescriptions and laboratory codes for CD4 count or HIV RNA assays. ARV use was identified from pharmacy claims. Risk of SGA (defined as birth weight below the 10th percentile for gestational age) and preterm birth was evaluated using logistic regression models.
RESULTS
Four hundred and seventy-seven HIV-infected pregnant women contributing 604 singleton pregnancies were identified; 156 (26%) delivered SGA infants. ARV use during pregnancy was not associated with SGA [adjusted odds ratio: 0.93; 95% confidence interval (CI): 0.56-1.56] or preterm birth (adjusted odds ratio: 0.74; 95% CI: 0.42-1.32). Exposure to a protease inhibitor during the first trimester was associated with a lower risk of SGA (odds ratio: 0.54; 95% CI: 0.29-1.01) compared with non-exposure to a protease inhibitor throughout pregnancy.
CONCLUSIONS
We observed no evidence of an association between ARV exposure during pregnancy and SGA delivery in this Medicaid cohort of HIV-infected women.
背景
多项研究评估了孕期使用抗逆转录病毒（ARV）疗法与小于胎龄儿（SGA）之间的关联，但证据仍未完全阐明。
方法
我们将田纳西医疗补助档案数据与生命记录相链接，以评估1994年至2009年间分娩的感染人类免疫缺陷病毒（HIV）女性的妊娠情况。根据诊断代码、ARV处方以及CD4细胞计数或HIV RNA检测的实验室代码来定义孕产妇的HIV状态。通过药房报销记录确定ARV的使用情况。使用逻辑回归模型评估SGA（定义为出生体重低于胎龄的第10百分位数）和早产的风险。
结果
共识别出477名感染HIV的孕妇，她们共有604例单胎妊娠；其中156例（26%）分娩出小于胎龄儿。孕期使用ARV与小于胎龄儿（校正比值比：0.93；95%置信区间[CI]：0.56 - 1.56）或早产（校正比值比：0.74；95% CI：0.42 - 1.32）均无关联。与整个孕期未接触蛋白酶抑制剂相比，孕早期接触蛋白酶抑制剂与较低的小于胎龄儿风险相关（比值比：0.54；95% CI：0.29 - 1.01）。
结论
在这个感染HIV女性的医疗补助队列中，我们未观察到孕期接触ARV与小于胎龄儿分娩之间存在关联的证据。
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