Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015;3(1):31-43.

Antiretroviral Therapy and Pregnancy Outcomes in Developing Countries: A Systematic Review

Fekadu Mazengia Alemu  1 , Alemayehu Worku Yalew  1 , Mesganaw Fantahun  1 , Eta Ebasi Ashu  2
Affiliations
Review

Antiretroviral Therapy and Pregnancy Outcomes in Developing Countries: A Systematic Review

Fekadu Mazengia Alemu et al. Int J MCH AIDS. 2015.

Abstract

Background: Despite significant efforts to understand adverse pregnancy outcome in women receiving Antiretroviral Therapy (ART), ART-related adverse birth outcomes are still poorly understood. We systematically review ART-related adverse birth outcomes among HIV-infected pregnant women; we also review the covariates associated with adverse birth outcomes in the aforementioned group.

Methods: The main source for our systematic review was electronic bibliographic databases. Databases such as MEDLINE, PubMed, EMBASE and AIDSLINE were searched. Furthermore, search engines such as Google and Google Scholar were specifically searched for gray literature. Methodological quality of available literature was assessed using the Newcastle - Ottawa Quality Assessment Scale & M. Hewitt guideline. We examined a total of 1,124 papers and reviewed the studies using the PICOT criteria which stands for Patient (population), Intervention (or "Exposure"), Comparison, Outcome and Type of study. Finally, 32 methodologically fit studies were retained and included in our review.

Results: Frequently observed adverse birth outcomes included low birth weight (LBW), Preterm Birth (PB), Small for Gestational Age (SGA), while still birth and congenital anomalies were infrequent. Type of regimen such as Protease Inhibitor (PI) based regimens and timing of initiation of ART are some of the factors associated with adverse pregnancy outcomes. Covariates principally included malnutrition and other co-morbidities such as malaria and HIV.

Conclusions and public health implications: There is growing evidence in published literature suggesting that ART might be causing adverse birth outcomes among pregnant women in developing countries. There is a need to consider regimen types for HIV-infected pregnant women. There is need to design large cohort studies.

Keywords: Adverse pregnancy outcomes; Antiretroviral Therapy; Developing countries; HAART; Low birth weight; Preterm delivery; Systematic review.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: No authors have financial interests that pose a conflict of interest.

Figures

Figure 1
Figure 1
Flow Diagram of the systematic review process, ART and pregnancy outcome, November 2013 (adopted from PRISMA tool)[54
See this image and copyright information in PMC

References

    1. World Health Organization (WHO) Global HIV/AIDS response:epidemic update and health sector progress towards universal access:progress report 2014. Geneva, Switzerland: 2011.
    1. Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO). HIV in pregnancy:A Review. Switzerland, Geneva: UNAIDS; 1998. Contract Number:WHO/RHT/98.24.
    1. Segurado AC, Paiva V. Rights of HIV positive people to sexual and reproductive health Parenthood. Reproductive Health Matters. 2007;15(29):27–45. Available at http://www.rhmjournal.org.uk/ - PubMed
    1. Mock PA SN, Bhadrakom C, Siriwasin W, Chotpitayasunondh T, Chearskul S, Young NL, Roongpisuthipong A, Chinayon P, Kalish ML, Parekh B, Mastro TD. Maternal viral load and timing of mother-to-child transmission, Bangkok, Thailand. Bangkok Collaborative perinatal HIV transmission study group. AIDS. 1999;13(3):407–14. - PubMed
    1. Bassey EA, Abasiubong F, Ekanem U, Abasiattai AA. Attitude of antenatal attendees to people living with HIV/AIDS in Ugo, South Nigeria. African Health Science. 2007;7(3):238. - PMC - PubMed

LinkOut - more resources