501: The use of protease inhibitors (PI) during pregnancy and the risk for intrauterine growth restriction in human immunodeficiency virus (HIV) positive women

Abstract

ObjectiveTo assess if the use of a PI is associated with an increased risk of adverse fetal outcome, particularly, the development of intrauterine fetal growth restriction (IUGR).Study DesignAn IRB-approved, chart review was performed from 01/2001-7/2008. Data abstracted included maternal age, race, CD4 count at the time of delivery, a history of preterm labor, presence of hypertension (HTN) and/or diabetes (DM), birth weight, Apgar scores, presence of abnormal Doppler studies, presence of oligohydramnios, gestational age at delivery and findings consistent with abruption. Fetal exposure to tobacco, alcohol and illicit drugs were also documented. The classes and times of initiation of antiretroviral agents used were evaluated. Categorical data were analyzed using the chi square test (or Fisher′s exact test where appropriate). Continuous variables were analyzed using the Student t test. A multinomial regression analysis was performed to assess for interactions between CD4 count, tobacco use, alcohol use, illicit drug use, class of antiretroviral drug used, race, and presence of HTN (using STATA 8.2, College Station, TX).Results102 patients were identified. 21 were on no therapy or a regimen that did not include a PI. 81 patients were on combination therapy that included a PI and 18 of them developed IUGR. Of those not on a PI, none developed IUGR (22% vs. 0%, p=0.02). Alcohol, tobacco or illicit drug use did not differ between the groups. No differences were noted between groups with respect to demographic characteristics or other obstetric outcome. After adjusting for confounders, the development of IUGR was still significantly associated with the use of a PI.ConclusionTabled 1ORP95% CITobacco2.4<0.0011.6-3.6PI2.00.0011.3-3.1Illicit drugs0.80.320.5-1.3Race1.10.670.8-1.6HTN0.60.410.2-1.9CD41.30.051.0-1.7 Open table in a new tab ObjectiveTo assess if the use of a PI is associated with an increased risk of adverse fetal outcome, particularly, the development of intrauterine fetal growth restriction (IUGR). To assess if the use of a PI is associated with an increased risk of adverse fetal outcome, particularly, the development of intrauterine fetal growth restriction (IUGR). Study DesignAn IRB-approved, chart review was performed from 01/2001-7/2008. Data abstracted included maternal age, race, CD4 count at the time of delivery, a history of preterm labor, presence of hypertension (HTN) and/or diabetes (DM), birth weight, Apgar scores, presence of abnormal Doppler studies, presence of oligohydramnios, gestational age at delivery and findings consistent with abruption. Fetal exposure to tobacco, alcohol and illicit drugs were also documented. The classes and times of initiation of antiretroviral agents used were evaluated. Categorical data were analyzed using the chi square test (or Fisher′s exact test where appropriate). Continuous variables were analyzed using the Student t test. A multinomial regression analysis was performed to assess for interactions between CD4 count, tobacco use, alcohol use, illicit drug use, class of antiretroviral drug used, race, and presence of HTN (using STATA 8.2, College Station, TX). An IRB-approved, chart review was performed from 01/2001-7/2008. Data abstracted included maternal age, race, CD4 count at the time of delivery, a history of preterm labor, presence of hypertension (HTN) and/or diabetes (DM), birth weight, Apgar scores, presence of abnormal Doppler studies, presence of oligohydramnios, gestational age at delivery and findings consistent with abruption. Fetal exposure to tobacco, alcohol and illicit drugs were also documented. The classes and times of initiation of antiretroviral agents used were evaluated. Categorical data were analyzed using the chi square test (or Fisher′s exact test where appropriate). Continuous variables were analyzed using the Student t test. A multinomial regression analysis was performed to assess for interactions between CD4 count, tobacco use, alcohol use, illicit drug use, class of antiretroviral drug used, race, and presence of HTN (using STATA 8.2, College Station, TX). Results102 patients were identified. 21 were on no therapy or a regimen that did not include a PI. 81 patients were on combination therapy that included a PI and 18 of them developed IUGR. Of those not on a PI, none developed IUGR (22% vs. 0%, p=0.02). Alcohol, tobacco or illicit drug use did not differ between the groups. No differences were noted between groups with respect to demographic characteristics or other obstetric outcome. After adjusting for confounders, the development of IUGR was still significantly associated with the use of a PI. 102 patients were identified. 21 were on no therapy or a regimen that did not include a PI. 81 patients were on combination therapy that included a PI and 18 of them developed IUGR. Of those not on a PI, none developed IUGR (22% vs. 0%, p=0.02). Alcohol, tobacco or illicit drug use did not differ between the groups. No differences were noted between groups with respect to demographic characteristics or other obstetric outcome. After adjusting for confounders, the development of IUGR was still significantly associated with the use of a PI. ConclusionTabled 1ORP95% CITobacco2.4<0.0011.6-3.6PI2.00.0011.3-3.1Illicit drugs0.80.320.5-1.3Race1.10.670.8-1.6HTN0.60.410.2-1.9CD41.30.051.0-1.7 Open table in a new tab