Integrase inhibitors not linked to neonatal weight

In a recent interview with Contemporary OB/GYN, Sara Edwards, MD, a second-year maternal-fetal medicine fellow at Mount Sinai, discussed the potential effects of prenatal antiviral therapy on fetal biometric measurements.

As HIV has become a well-managed chronic condition, many pregnant patients are on long-term antiretroviral therapy (ART). Edwards explained that while ART has significantly improved health outcomes for individuals with HIV, some classes of these medications have been associated with metabolic changes, including weight gain and metabolic syndrome in adults. Given these observed effects, she sought to investigate whether ART, particularly integrase inhibitors, could similarly impact fetal growth, leading to larger infants or central obesity, which could increase pregnancy-related complications.

Edwards' study analyzed data from 155 patients from a high-risk clinic, all of whom were on ART, had undergone ultrasound evaluations, and ultimately delivered at Mount Sinai. Within this cohort, 106 patients were taking integrase inhibitors, a class of HIV medications often linked to increased weight gain in adults. The study aimed to determine whether fetuses exposed to these medications exhibited increased biometric measurements in utero or were born with higher birth weights. Secondary outcomes included complications associated with larger infants, such as postpartum hemorrhage or cesarean delivery because of labor difficulties.

The study found no statistically significant differences in fetal biometric measurements or neonatal weight between patients taking integrase inhibitors and those on other ARTs. However, the group taking integrase inhibitors showed a higher prevalence of obesity and gestational diabetes, both of which could have implications for fetal growth and pregnancy outcomes. These findings suggest a possible association between integrase inhibitors and maternal metabolic changes, though further research is needed to establish a definitive link.

Edwards emphasized that, despite the lack of conclusive evidence, clinicians should be aware of the potential for increased fetal growth in patients on integrase inhibitors. While these medications remain highly effective and well-tolerated, it is important for health care providers to remain vigilant and prepared for any complications that may arise. She suggested that larger studies would be beneficial in determining whether a stronger link exists between integrase inhibitors and fetal growth outcomes. Until then, physicians should consider these potential risks when managing pregnant patients with HIV to ensure optimal maternal and fetal health.