Children whose mothers took antiretroviral medication for HIV while pregnant may have higher risks for developmental delays at age 5, according to new research.
Nonetheless, researchers said it’s important for women with HIV to take antiretroviral therapy during pregnancy to prevent HIV transmission to their fetus. Women who have HIV and know it should start on antiretroviral therapy in case they do become pregnant, the authors said.
Researchers for the Pediatric HIV/AIDS Cohort Study, including Tzy-Jyun Yao of Harvard T.H. Chan School of Public Health, said the findings underscore the need to monitor the neurodevelopment of children whose mothers took antiretrovirals during pregnancy.
They also called for a further look at the timing of a fetus’s first exposure to antiretrovirals in the womb.
Among other findings, the risk of developmental delays was even higher for children whose mothers’ regimens contained the drug atazanavir, compared to regimens that did not.
Worldwide, about 15.4 million children under 15 who were exposed to the virus in the womb do not have HIV because of the success of antiretroviral therapy.
While the drugs greatly reduce the odds of pregnant women transmitting the virus to her fetus, past research had suggested the drugs may also increase the odds for delays in language and cognitive skills as well as behavioral challenges.
The developing fetal brain is susceptible to a variety of environmental influences, the authors said. It can be difficult to know whether the medications caused the delays or if they were a result of such factors as poor parental health, substance use or insufficient oxygen and nutrition.
Most previous studies of exposure to antiretroviral therapy in the uterus among children without HIV have evaluated only individual areas of neurodevelopment, the authors said.
For this study, investigators evaluated potential effects of the therapy on language, emotional-behavioral development and cognition.
Children were assessed at age 5. Researchers compared exposure to regimens with atazanavir to drug combinations without it. They also looked at whether these effects were different for children whose mothers were receiving antiretroviral therapy before they got pregnant, compared to those whose mothers began treatment after they got pregnant.
Of 230 children whose mothers were already receiving treatment when they became pregnant, 15% had lower scores in one area of development, and 8% had challenges in at least two of the three, the study found.
Among the 461 children whose mothers began therapy during pregnancy, 21% had a delay in one area and 12% had delays in at least two of the three developmental areas.
Among the children whose mothers started treatment during pregnancy, those whose mothers’ regimens included atazanavir had a 70% greater chance for a developmental delay.
The study was funded by the U.S. National Institutes of Health and published recently in AIDS Patient Care and STDS.
The American College of Obstetricians and Gynecologists has more on pregnancy and HIV.
SOURCE: U.S. National Institute of Child Health and Human Development, news release, March 24, 2023
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