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• W186208561 abstract "To the Editor: Efavirenz a pregnancy risk category D antiretroviral (ARV) drug has been associated with the development of anecephaly myelomeningocele and microphthalmia in animal models. Four retrospective cases of neural tube defects have been reported in human fetuses but limited obstetric and neonatal outcome data on the risk associated with efavirenz are available. The US prospective pregnancy registry has detected no increase in risk of birth defects following exposure to efavirenz in the first trimester and many clinicians believe that risks to the fetus may have been exaggerated. These conflicting opinions led us to evaluate the obstetric and neonatal outcomes of pregnant patients on efavirenz at our ARV clinic since 2002. A total of 37 out of 50 women had analysable data. Their average age was 32 years WHO stage 3 weight 66 kg baseline CD4 count 136 cells/ microl and viral load 352 919 copies/ml. The CD4 count improved on highly active antiretroviral therapy (HAART) with the average count of 245 cells/ microl at pregnancy detection improving to 296 cells/ microl at delivery. The average viral load also improved decreasing from an average of 62 630 copies/ml at pregnancy detection to 8 810 copies/ml at delivery. Obstetric outcomes. Of the women 15% decided to have a termination of pregnancy 29% had a caesarean section which compares favourably with the Gauteng provincial caesarean section rate of 17.7% and 34% delivered at a level 2 hospital (Kalafong Hospital Neonatal Statistics January - December 2006 -unpublished). There were no reported cases of premature rupture of membranes or chorio-amnionitis. Neonatal outcomes. The average birth weight was 2 260 g (range 2 320 - 3 000 g). Eleven per cent of women had a low-birth-weight baby comparing well with the Gauteng provincial rate of 18%4 and level 2 hospital rate of 19.2% (Kalafong Hospital Neonatal Statistics January - December 2006 -unpublished). There was no significant association between birth of a low-birth-weight baby and the age weight WHO stage or parity of the mother or her CD4 count and viral load at any stage before or during her pregnancy. There was 1 neonatal death due to respiratory distress. Significantly there were no reported cases of morphological abnormalities neural tube defects or overt developmental delay. Only 12 mothers brought their babies for their HIV polymerase chain reaction test at 6 weeks; 1 baby tested positive for HIV (8%). Conclusion. No increased risk of adverse obstetric and neonatal outcomes was demonstrated in a small number of HIV-positive women who fell pregnant while taking efavirenz. Limitations of the study are the small number of cases the retrospective nature of the analysis and the limited number of first-trimester exposures. The study highlights the need for active pregnancy surveillance of this new class of medication and the urgent need to monitor neonates exposed to ARVs. We therefore propose that a formal prospective multi-site pregnancy registry be established and invite interested parties to contact me for information on participation. (full text)" @default.
• W186208561 created "2016-06-24" @default.
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• W186208561 date "2007-11-01" @default.
• W186208561 modified "2023-09-26" @default.
• W186208561 title "Quantifying antiretroviral risk in pregnancy." @default.
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