Maternal Antiretroviral Use and the Risk of Prematurity and Low Birth Weight in Perinatally HIV-Exposed Children – 7 Years’ Experience in Two Romanian Centers

Background and Objectives: In the context of free access to antiretroviral treatment for pregnant women in Romania since 2001 and the proven efficacy in vertical transmission of HIV, the impact on newborns exposed to HIV and antiretroviral drugs is concerning. The study focused on prematurity and low birth weight in antiretroviral HIV exposed children in two major Romanian centers, Bucharest and Constanța. Materials and Methods: A retrospective observational study was performed including couples of HIV infected women and their live singleton newborns from 2006 and 2012. Preterm delivery was defined as birth before week 37 and low birth weight was defined as birth weight less than 2500g. Results: The total number 352 children and 313 women were enrolled. Mean maternal age at delivery was 23.1 years. Mean newborns birth weight was 2726g. In the children group 191 (54.2%) were boys and the rate of HIV transmission was 13.9%.The prematurity rate was 21.5% and low birth rate was 25.56%. Preterm birth was associated with high HIV RNA in the third trimester, and HIV positive final status in infants and vaginal delivery. Low birth weight was associated with lack of antiretroviral treatment during pregnancy and HIV positive status in infants. Prematurity and low birth weight were not associated with antiretroviral class, any specific antiviral drug, maternal number of regimens or duration of antiretroviral treatment prior conception, nor with maternal exposure during puberty. Conclusions: Prematurity rate was higher in HIV vertically infected newborns and those exposed to high level of maternal viral replication during the last trimester of pregnancy. Low birth weight rate was associated with lack of in utero antiretroviral exposure. Prematurity and low birth weight were not associated with any antiretroviral class or specific antiretroviral drug, duration and number of regimens before conception or with maternal exposure during childhood and puberty.