Open AccessPerinatal outcomes following maternal pre‐exposure prophylaxis (Pr EP ) use during pregnancy: results from a large Pr EP implementation program in Kenya
Author(s) -
Dettinger Julia C,
Kinuthia John,
Pintye Jillian,
Abuna Felix,
Begnel Emily,
Mugwanya Kenneth,
Sila Joseph,
Lagat Harison,
Baeten Jared M,
JohnStewart Grace
Publication year - 2019
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25378
Subject(s) - medicine , pregnancy , obstetrics , gestational age , population , prenatal care , logistic regression , pediatrics , environmental health , genetics , biology
The World Health Organization, while recommending pre‐exposure prophylaxis (Pr EP ) for HIV ‐negative pregnant and postpartum women in HIV high‐burden settings, advocates for continued safety evaluation of Pr EP in this population. Methods The Pr EP Implementation in Young Women and Adolescents (Pr IYA ) program delivered Pr EP to pregnant and postpartum women integrated within routine maternal and child health clinics ( MCH ) at 16 sites in Western Kenya. Pr EP exposure and perinatal outcome data were collected among women obtaining postnatal services during programme evaluation. Pr EP use was self‐reported and confirmed with clinical records. Perinatal outcomes including gestational age at birth, birthweight, congenital malformations and infant growth outcomes were abstracted from clinical records for mother‐infant pairs attending the six week visit. Associations between infant outcomes and maternal prenatal Pr EP use were assessed using univariate and multivariate logistic and linear regression. Results The Pr IYA evaluation identified 1530 postpartum mother‐infant pairs with data on prenatal Pr EP exposure: 206 with prenatal Pr EP use, 1324 without. Median maternal age was 24 years in both groups. Pr EP users (any reported Pr EP use) were significantly more likely to report HIV risk factors such as: intimate partner violence, sexually transmitted infections and having a partner with positive or unknown HIV status. Most mothers initiated Pr EP during the second trimester (n = 116, 57%) and used Pr EP for more than one month (n = 110, 58%). The mean birthweight was 3.3 kg and gestational age at birth was 38.5 weeks in both groups. There were no major differences between Pr EP exposed and unexposed infants in rates of preterm birth and low birthweight. There were no congenital malformations identified in the Pr EP ‐exposed group and five reported in the Pr EP unexposed group. At six weeks postpartum, infants in both groups had similar growth. No differences in infant outcomes were found by duration Pr EP exposure, trimester of Pr EP initiation, a subset analysis of women 15 to 24 years old or in multivariate analyses. This analysis demonstrates that monitoring of infant outcomes is feasible within large‐scale programmatic implementation of Pr EP among pregnant and postpartum populations. Conclusions Pregnancy outcomes and early infant growth did not differ by Pr EP exposure.