Quantifying antiretroviral risk in pregnancy.

摘要: To the Editor: Efavirenz a pregnancy risk category D antiretroviral (ARV) drug has been associated with development of anecephaly myelomeningocele and microphthalmia in animal models. Four retrospective cases neural tube defects have reported human fetuses but limited obstetric neonatal outcome data on efavirenz are available. The US prospective registry detected no increase birth following exposure to first trimester many clinicians believe that risks fetus may exaggerated. These conflicting opinions led us evaluate outcomes pregnant patients at our ARV clinic since 2002. A total 37 out 50 women had analysable data. Their average age was 32 years WHO stage 3 weight 66 kg baseline CD4 count 136 cells/ microl viral load 352 919 copies/ml. improved highly active therapy (HAART) 245 detection improving 296 delivery. also decreasing from an 62 630 copies/ml 8 810 Obstetric outcomes. Of 15% decided termination 29% caesarean section which compares favourably Gauteng provincial rate 17.7% 34% delivered level 2 hospital (Kalafong Hospital Neonatal Statistics January - December 2006 -unpublished). There were premature rupture membranes or chorio-amnionitis. 260 g (range 320 000 g). Eleven per cent low-birth-weight baby comparing well 18%4 19.2% significant association between parity mother her any before during pregnancy. 1 death due respiratory distress. Significantly there morphological abnormalities overt developmental delay. Only 12 mothers brought their babies for HIV polymerase chain reaction test 6 weeks; tested positive (8%). Conclusion. No increased adverse demonstrated small number HIV-positive who fell while taking efavirenz. Limitations study nature analysis first-trimester exposures. highlights need surveillance this new class medication urgent monitor neonates exposed ARVs. We therefore propose formal multi-site be established invite interested parties contact me information participation. (full text)