RESUMO
Limited evidence is available regarding antiretroviral (ARV) safety for uninfected infants exposed to these drugs in utero. Our objective was to determine if ARV administered to pregnant women is associated with decreasing umbilical arterial pH and base excess in uninfected infants. A prospective study was conducted on 57 neonates divided into three groups: ZDV group, born to mothers taking zidovudine (N = 20), triple therapy (TT) group, born to mothers taking zidovudine + lamivudine + nelfinavir (N = 25), and control group (N = 12), born to uninfected mothers. Umbilical cord blood was used to determine umbilical artery gases. A test was performed to calculate the sample by comparing means by the unpaired one-tailed t-test, with a = 0.05 and ß = 20 percent, indicating the need for a sample of 18 newborn infants for the study groups to detect differences higher than 20 percent. The control and ARV groups were similar in gestational age, birth weight, and Apgar scores. Values of pH, pCO2, bicarbonate, and base excess in cord arterial blood obtained at delivery from the newborns exposed to TT were 7.23, 43.2 mmHg, 19.5 mEq/L, and -8.5 nmol/L, respectively, with no significant difference compared to the control and ZDV groups. We conclude that intrauterine exposure to ARV is not associated with a pathological decrease in umbilical arterial pH or base excess. While our data are reassuring, follow-up is still limited and needs to be continued into adulthood because of the possible potential for adverse effects of triple antiretroviral agents.
Assuntos
Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Equilíbrio Ácido-Base/efeitos dos fármacos , Fármacos Anti-HIV/uso terapêutico , Sangue Fetal/química , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/efeitos adversos , Estudos de Casos e Controles , Quimioterapia Combinada , Infecções por HIV/sangue , Concentração de Íons de Hidrogênio/efeitos dos fármacos , Transmissão Vertical de Doenças Infecciosas , Lamivudina/efeitos adversos , Lamivudina/uso terapêutico , Nelfinavir/efeitos adversos , Nelfinavir/uso terapêutico , Resultado da Gravidez , Estudos Prospectivos , Zidovudina/efeitos adversos , Zidovudina/uso terapêuticoRESUMO
We studied patterns of antenatal care in low- versus high-risk pregnancies in Lebanon comparing 538 women after delivery in urban Beirut with rural Baka'a. Most women had 9 antenatal care visits with an obstetrician, starting in the first trimester. Care for high-risk and low-risk pregnancies was similar in terms of type of provider, number of visits and timing of first visit. More high-risk women had advice about special diets, supplements and laboratory tests. Maternal and fetal outcomes showed that, controlling for area and pregnancy risk, more antenatal visits were associated with fewer preterm deliveries, more caesarean sections and fewer cases of postpartum depression. Overall, differences between risk groups were small