Background. It is unknown whether adverse birth
outcomes are associated with maternal highly active antiretroviral therapy (HAART) in
pregnancy, particularly in resource-limited settings.
Methods. We abstracted obstetrical records at 6 sites
in Botswana for 24 months. Outcomes included stillbirths (SBs), preterm delivery (PTD),
small for gestational age (SGA), and neonatal death (NND). Among human immunodeficiency
virus (HIV)–infected women, comparisons were limited to HAART exposure status at
conception, and those with similar opportunities for outcomes. Comparisons were adjusted
for CD4+ lymphocyte cell count.
Results. Of 33 148 women, 32 113
(97%) were tested for HIV, of whom 9504 (30%) were HIV infected. Maternal
HIV was significantly associated with SB, PTD, SGA, and NND. Compared with all other
HIV-infected women, those continuing HAART from before pregnancy had higher odds of PTD
(adjusted odds ratio [AOR], 1.2; 95% confidence interval [CI], 1.1, 1.4), SGA (AOR,
1.8; 95% CI, 1.6, 2.1) and SB (AOR, 1.5; 95% CI, 1.2, 1.8). Among women
initiating antiretroviral therapy in pregnancy, HAART use (vs zidovudine) was associated
with higher odds of PTD (AOR, 1.4; 95% CI, 1.2, 1.8), SGA (AOR, 1.5; 95% CI,
1.2, 1.9), and SB (AOR, 2.5; 95% CI, 1.6, 3.9). Low CD4+ was
independently associated with SB and SGA, and maternal hypertension during pregnancy with
PTD, SGA, and SB.
Conclusions. HAART receipt during pregnancy was
associated with increased PTD, SGA, and SB.