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Weight gain during pregnancy among
women initiating dolutegravir in Botswana
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"Neither group (DTG or EFV) gained as much weight as HIV-uninfected women.”
Ellen C. Canigliaa,b,*, Roger Shapirob,c, Modiegi Disekoc, Blair J. Wylied, Chloe Zerad,
Sonya Daveye, Arielle Isaacsonc, Gloria Mayondic, Judith Mabutac, Rebecca Luckettd,
Joseph Makhemac, Mompati Mmalanec, Shahin Lockmanc,f, Rebecca Zashc,d
We used a large birth outcomes surveillance study in Botswana to provide the first data on gestational weight gain after initiating DTG-based ART in pregnancy. We found that compared with women initiating EFV during pregnancy, women initiating DTG gained more weight, and were less likely to lose weight, between 18±2 and 36±2 weeks gestation. However, women initiating DTG and EFV both gained less weight, were more likely to gain insufficient weight, and were more likely to lose weight than HIV-uninfected women.
HIV-uninfected women have the highest risk of excess weight gain and the lowest risks of insufficient weight gain and weight loss. Our findings highlight a high overall risk of insufficient weight gain (>24%) and weight loss (>7%) in HIV-positive women initiating ART during pregnancy.
Our findings of increased weight gain with DTG-based ART are consistent with two randomized clinical trials in non-pregnant adults. The ADVANCE trial showed adults initiating DTG gained 2kg-5 kg more than adults initiating EFV after 48 weeks [9] and the NAMSAL trial showed adults initiating DTG gained 2 kg more than adults initiating EFV after 48 weeks, [8] with greater weight gain in women compared to men.
Unlike these two trials, our study also compared weight gain to HIV-uninfected women, who had more gestational weight gain than both women on DTG and EFV and less weight loss.
We found that women initiating DTG during pregnancy gained more weight than women initiating EFV during pregnancy, corresponding to more excess weight gain but also less insufficient weight gain and less weight loss. Neither group gained as much weight as HIV-uninfected pregnant women. Our findings additionally highlight a high overall risk of insufficient weight gain and weight loss in HIV-positive women initiating ART during pregnancy.
Average weekly weight gain and total 18-week weight gain from 18±2 to 36±2 weeks was lower for women initiating EFV than women initiating DTG and both groups had less weight gain than HIV-uninfected women (Table 2).
Almost one quarter of HIV-uninfected women (23.1%) gained more weight than the IOM recommended amount (0.59 kg/week), compared with 12.9% of women initiating DTG and 9.1% of women initiating EFV. The adjusted risk ratio for excess weight gain was 1.44 (1.11, 1.87) for women initiating DTG and 2.41 (1.81, 3.21) for HIV-uninfected women, compared with women initiating EFV.
In contrast, 27.7% of women initiating EFV gained less weight than the IOM recommended amount (0.18 kg/week), compared with 20.2% of women initiating DTG and 11.1% of HIV-uninfected women.
The adjusted risk ratio for insufficient weight gain was 0.73 (0.63, 0.86) for women initiating DTG and 0.48 (0.41, 0.57) for HIV-uninfected women, compared with women initiating EFV. More women initiating EFV lost weight (9.4%) than women initiating DTG (4.4%) and HIV-uninfected women (2.2%). The adjusted risk ratio for losing weight was 0.43 (0.28, 0.67) for DTG and 0.30 (0.19, 0.47) for HIV-uninfected women, compared with women initiating EFV (Table 3).
Women weighing <50 kg in early pregnancy gained more weight than women weighing ≥80 kg in early pregnancy. The adjusted mean differences in weight gain comparing women initiating DTG with women initiating EFV were larger among women weighing ≥80 kg in early pregnancy and attenuated among women weighting <50 kg in early pregnancy, but were largely unchanged when comparing HIV-uninfected women to women initiating EFV. Primigravid women gained more weight than non-primigravid women, but the adjusted mean differences were similar (Fig. 2 and Appendix Table 1).
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Weight gain during pregnancy among women initiating dolutegravir in Botswana
December 2020
Abstract
Background
Recent data suggests clinically significant weight gain among non-pregnant HIV-positive adults after starting dolutegravir-based ART (DTG). Excess or insufficient weight gain in pregnancy could adversely impact pregnancy outcomes, but data for pregnant women receiving DTG are limited.
Methods
The Tsepamo Study captured data at delivery sites in Botswana from 2014 to 2019. HIV testing, HIV treatment information, and weight measurements during antenatal care were abstracted from the maternity obstetric record at delivery. HIV-positive women initiating DTG or efavirenz-based ART (EFV) between conception and 17 weeks gestation and HIV-uninfected women first presenting for antenatal care before 17 weeks gestation were included. We evaluated weekly weight gain, total 18-week weight gain, excess weight gain (>0.59 kg/week), insufficient weight gain (<0.18 kg/week), and weight loss between 18±2 and 36±2 weeks gestation, adjusting for demographic and clinical variables.
Findings
Baseline characteristics were similar by exposure group, including pre-pregnancy and early pregnancy weight. Compared with EFV, mean weekly weight gain between 18 and 36 weeks gestation was 0.05 (95% CI 0.03, 0.07) kg/week higher for women initiating DTG and 0.12 (0.10, 0.14) kg/week higher for HIV-uninfected women. Mean 18-week weight gain was 1.05 (95% CI 0.61, 1.49) kg higher for women initiating DTG and 2.31 (1.85, 2.77) kg higher for HIV-uninfected women, compared with EFV. Women initiating DTG were more likely to gain excess weight but less likely to gain insufficient weight or lose weight than women initiating EFV.
Interpretation
Women initiating DTG compared with EFV during pregnancy gained more weight between 18 and 36 weeks gestation. Neither group gained as much weight as HIV-uninfected women. Initiating DTG compared with EFV during pregnancy could increase the risk of excess weight gain but decrease the risk of insufficient weight gain and weight loss, which could have positive and negative consequences in pregnancy. Our findings are consistent with prior studies in non-pregnant adults.
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