Neural Tube Defects in Pregnancies Among Women With Diagnosed HIV Infection — 15 Jurisdictions, 2013–2017
Authors: Jennita Reefhuis, Lauren F. FitzHarris, Kristen Mahle Gray, Steven Nesheim, Sarah C. Tinker, Jennifer Isenburg, Benjamin T. Laffoon, Joseph Lowry, Karalee Poschman, Janet D. Cragan, Fay K. Stephens, Jane E. Fornoff, Cheryl A. Ward, Tri Tran, Ashley E. Hoover, Eirini Nestoridi, Laura Kersanske, Monika Piccardi, Morgan Boyer, Mary M. Knapp, Abdel R. Ibrahim, Marilyn L. Browne, Bridget J. Anderson, Dipal Shah, Nina E. Forestieri, Jason Maxwell, Kimberlea W. Hauser, Godwin U. Obiri, Rachel Blumenfeld, Dana Higgins, Carla P. Espinet, Bernardita López, Katherine Zielke, Latoya P. Jackson, Charles Shumate, Kacey Russell, Margaret A. Lampe
Journal: MMWR Morbidity and Mortality Weekly Report (2020)

In May 2018, a study of birth defects in infants born to women with diagnosed human immunodeficiency virus (HIV) infection in Botswana reported an eightfold increased risk for neural tube defects (NTDs) among births with periconceptional exposure to antiretroviral therapy (ART) that included the integrase inhibitor dolutegravir (DTG) compared with other ART regimens (1). The World Health Organization* (WHO) and the U.S. Department of Health and Human Services† (HHS) promptly issued interim guidance limiting the initiation of DTG during early pregnancy and in women of childbearing age with HIV who desire pregnancy or are sexually active and not using effective contraception. On the basis of additional data, WHO now recommends DTG as a preferred treatment option for all populations, including women of childbearing age and pregnant women. Similarly, the U.S. recommendations currently state that DTG is a preferred antiretroviral drug throughout pregnancy (with provider-patient counseling) and as an alternative antiretroviral drug in women who are trying to conceive.§ Since 1981 and 1994, CDC has supported separate surveillance programs for HIV/acquired immunodeficiency syndrome (AIDS) (2) and birth defects (3) in state health departments. These two surveillance programs can inform public health programs and policy, linkage to care, and research activities. Because birth defects surveillance programs do not collect HIV status, and HIV surveillance programs do not routinely collect data on occurrence of birth defects, the related data have not been used by CDC to characterize birth defects in births to women with HIV. Data from these two programs were linked to estimate overall prevalence of NTDs and prevalence of NTDs in HIV-exposed pregnancies during 2013-2017 for 15 participating jurisdictions. Prevalence of NTDs in pregnancies among women with diagnosed HIV infection was 7.0 per 10,000 live births, similar to that among the general population in these 15 jurisdictions, and the U.S. estimate based on data from 24 states. Successful linking of data from birth defects and HIV/AIDS surveillance programs for pregnancies among women with diagnosed HIV infection suggests that similar data linkages might be used to characterize possible associations between maternal diseases or maternal use of medications, such as integrase strand transfer inhibitors used to manage HIV, and pregnancy outcomes. Although no difference in NTD prevalence in HIV-exposed pregnancies was found, data on the use of integrase strand transfer inhibitors in pregnancy are needed to understand the safety and risks of these drugs during pregnancy.