Effects of maternal antiretroviral drugs in pregnancy on haematological and biochemical parameters in neonates exposed in utero

Abstract

Background

The British HIV Association recommends the use of antiretroviral therapy (ART) in all pregnant women living with HIV to protect against mother to child transmission. ART may cause side effects including anaemia, macrocytosis and neutropenia.

Methods

In a retrospective study conducted in a District General Hospital in the United Kingdom in 2024 using a historical cohort, we compared neonatal haemoglobin, mean corpuscular volume (MCV), reticulocyte, neutrophil and lymphocyte counts, alanine aminotransferase and bilirubin levels on the first day of life and at 6 weeks of life in children born to mothers who at delivery were on azidothymidine (AZT) containing ART regimes with newborns not exposed to those regimes.

Results

Our study included 82 newborns exposed to maternal AZT-containing ART and 36 without exposure to an AZT-containing regimen. Newborns exposed to AZT had a mean (SD) haemoglobin of 15.5 (2.3) g/dl and a reticulocyte count of 216.8 (67.1) x10³/microliter, which were significantly lower compared to newborns not exposed with a haemoglobin of 17.6 (1.8) and a reticulocyte count of 273.1 (97.8) on the day of delivery. The MCV was with a mean (SD) of 117.2 (11.5) significantly higher in newborns exposed compared to those not exposed: 106.4 (17.1). There was no difference in other parameters at birth or in the above at 6 weeks of age.

Conclusions

Exposure to ART regimens containing AZT in pregnancy was associated with features of reduced fetal erythropoiesis in newborns.

Keywords

Zidovudine protease inhibitors nucleoside reverse transcriptase inhibitors haemoglobin anemia macrocytosis reticulocyte count bilirubin alanine aminotransferase

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