Background:
In non-pregnant adults, some studies suggest dolutegravir (DTG) is associated with increased risk of hypertension (HTN). Given the serious implications of HTN for pregnancy outcomes, we compared the risk of hypertensive disorders of pregnancy (HDP) among pregnant people on DTG-based antiretroviral treatment (ART) to those on efavirenz (EFV)-based ART and to pregnant people without HIV (w/o HIV).
Methods:
Methods: Among deliveries captured by the Tsepamo Birth Outcomes Surveillance Study (8/2014-8/2022), we included people who presented to antenatal care prior to 20 weeks gestational age (GA) and were either w/o HIV or with HIV and conceived 0.5-5 years after starting DTG- or EFV-based ART. Blood pressures (BP) and medical history of HTN were abstracted from antenatal medical records. Chronic HTN was defined as a pre-pregnancy history of HTN or HTN (systolic BP >140 or diastolic BP >90 mm Hg) before 20 weeks GA. HDP was onset of any HTN (including mild and severe) >20 weeks and predelivery among women without chronic HTN. We determined proportions with chronic HTN and HDP by exposure group, and fit multivariable log-binomial regression models to estimate the adjusted risk ratio (aRR) of HDP in the EFV and w/o HIV groups each compared to the DTG group, adjusted for maternal age, marital status, education, and tertiary delivery site.
Results:
Of 265,410 deliveries in the study period, we included 127,946; 5,866 conceiving on DTG, 4,771 conceiving on EFV, and 117,309 w/o HIV. Median maternal age was 25 yrs in those w/o HIV and 31 yrs in the DTG and EFV groups (Table 1). The prevalence of chronic HTN was 4.4%, 4.4% and 4.6% and the risk of HDP was 10.2%, 8.1% and 11.7% in the DTG, EFV and w/o HIV groups, respectively. The risk of HDP was 20% lower (aRR=0.80, 95% CI 0.71,0.91) in the EFV group and 20% higher (aRR=1.20, 95% CI 1.10,1.30) in the w/o HIV group, compared to the DTG group.
Conclusions:
The prevalence of chronic HTN was similar across exposure groups. While pregnant people who conceived on DTG-based ART had a higher risk of HDP than those on an EFV-based regimen, both groups had a lower risk than those without HIV. In future analyses it will be important to elucidate the mechanisms responsible for these differences, including the impact of weight and weight gain.
