title: Preterm Birth and Low Birth Weight after In Utero Exposure to Antiretrovirals Initiated during Pregnancy in Yaoundé, Cameroon.
abstract: BACKGROUND
  Effects of antiretroviral therapy (ART) on birth outcomes remain controversial.
  
  
  OBJECTIVE
  To assess the impact of antenatal exposure to ART on the occurrence of preterm birth (PTB) and low birth weight (LBW).
  
  
  METHODS
  A cross-sectional study conducted at the Essos Hospital Center in Yaounde from 2008 to 2011 among HIV vertically exposed infants with two distinct maternal antiretroviral experiences: monotherapy group (Zidovudine, ZDV) and the combination ART group (cART). Mothers already receiving cART before pregnancy were ineligible. In both groups, events of PTB (<37 weeks) and LBW (<2,500g) were analyzed using univariate and multivariate logistic regression; with p<0.05 considered statistically significant.
  
  
  RESULTS
  Of the 760 infants, 481 were born from cART-exposed mothers against 279 from maternal-ZDV. Median maternal CD4 count was 378 [interquartile range (IQR): 253-535] cells/mm3. Median duration of ART at onset of delivery was 13 [IQR: 10-17] weeks. In the cART-group, 64.9% (312/481) of mothers were exposed to Zidovudine/Lamuvidine/Nevirapine and only 2% (9/481) were on protease inhibitor-based regimens. Events of PTB were not significantly higher in the cART-group compared to the ZDV-group (10.2% vs. 6.4% respectively, p = 0.08), while onsets of LBW were significantly found in the cART-group compared to ZDV-group (11.6% vs. 7.2% respectively, p = 0.05). Other factors (parity, maternal age at delivery or CD4 cell count) were not associated with PTB.
  
  
  CONCLUSIONS
  cART, initiated during pregnancy, would be an independent factor of LBW. In the era of option B+ (lifelong ART to all HIV-pregnant women), further studies would guide towards measures limiting onsets of LBW.
authors.affiliation: Department of Pediatrics, National Social Insurance Fund Hospital, Essos Hospital Center, Yaoundé, Cameroon.
authors.forename: Anne Esther
authors.initials: AE
authors.lastname: Njom Nlend
authors.affiliation: Department of Pediatrics, National Social Insurance Fund Hospital, Essos Hospital Center, Yaoundé, Cameroon.
authors.forename: Annie
authors.initials: A
authors.lastname: Nga Motazé
authors.affiliation: Department of Pediatrics, National Social Insurance Fund Hospital, Essos Hospital Center, Yaoundé, Cameroon.
authors.forename: Suzie
authors.initials: S
authors.lastname: Moyo Tetang
authors.affiliation: Department of Pediatrics, National Social Insurance Fund Hospital, Essos Hospital Center, Yaoundé, Cameroon.
authors.forename: Cécile
authors.initials: C
authors.lastname: Zeudja
authors.affiliation: Independent Consultant, Paris, France.
authors.forename: Marcus
authors.initials: M
authors.lastname: Ngantcha
authors.affiliation: Epidemiology and Public Health unit, Centre Pasteur of Cameroon, Yaoundé, Cameroon.
authors.forename: Mathurin
authors.initials: M
authors.lastname: Tejiokem
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D002163:Cameroon / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D009035:Mothers; D015999:Multivariate Analysis; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology*; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents