(346) Effects of antiretroviral therapy on fetal biometric measurements and neonatal weight

Objective: Several types of antiretroviral therapy used in the treatment of HIV, such as integrase inhibitors, have been linked to increased risk of metabolic syndrome in adults. This study assessed if these antiretroviral medications that cause metabolic syndrome in adults have similar effects on fetal weight and abdominal circumference when taken by HIV patients during pregnancy.

Study Design: Retrospective cohort study of HIV-positive pregnant patients at a single academic institution in New York City who delivered from 2014-2023. Patients were included if they had at least one ultrasound assessing fetal growth. Demographics, medical co-morbidities, antiretroviral medications, intrapartum complications, and birthweight were extracted from the electronic medical record. We extracted estimated fetal weight and abdominal circumference from the last ultrasound for each pregnancy. Bivariate analysis was performed to assess the difference between neonatal birthweight and estimated fetal abdominal circumference between those on antiretroviral therapy associated with metabolic syndrome (integrase inhibitors) and those on other antiretrovirals.

Results: Among 155 patients meeting inclusion criteria, 106 (68%) were taking integrase inhibitors and 49 (32%) were on other antiretrovirals. There was no significant difference in neonatal birthweight (p = 0.3), birthweight percentile (p = 0.4), or sonographic estimate of fetal abdominal circumference percentile (p = 0.57, Table 1) despite increased rates of gestational diabetes and obesity. Additionally, there were no significant differences in obstetric outcomes associated with macrosomia, including postpartum hemorrhage or cesarean delivery for labor abnormalities.

Conclusion: Although specific antiretroviral medications are associated with metabolic syndrome in adults, these regimens do not appear to be associated with increased birthweight or abnormal fetal biometric measurements, such as elevated abdominal circumference, when taken in pregnancy. Further examination among larger datasets is needed, as well as comparison with HIV negative patients.