Weight gain during pregnancy among women initiating dolutegravir in Botswana

Ellen C Caniglia; Roger Shapiro; Modiegi Diseko; Blair J Wylie; Chloe Zera; Sonya Davey; Arielle Isaacson; Gloria Mayondi; Judith Mabuta; Rebecca Luckett; Joseph Makhema; Mompati Mmalane; Shahin Lockman; Rebecca Zash

doi:10.1016/j.eclinm.2020.100615

Weight gain during pregnancy among women initiating dolutegravir in Botswana

EClinicalMedicine. 2020 Nov 5:29-30:100615. doi: 10.1016/j.eclinm.2020.100615. eCollection 2020 Dec.

Authors

Ellen C Caniglia^{1

2}, Roger Shapiro^{2

3}, Modiegi Diseko³, Blair J Wylie⁴, Chloe Zera⁴, Sonya Davey⁵, Arielle Isaacson³, Gloria Mayondi³, Judith Mabuta³, Rebecca Luckett⁴, Joseph Makhema³, Mompati Mmalane³, Shahin Lockman^{3

6}, Rebecca Zash^{3

4}

Affiliations

¹ Department of Population Health, New York University School of Medicine, New York, United States.
² Harvard T.H. Chan School of Public Health, Boston, United States.
³ Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.
⁴ Beth Israel Deaconess Medical Center, Boston, United States.
⁵ University of Pennsylvania Perelman School of Medicine, Philadelphia, United States.
⁶ Brigham and Women's Hospital, Boston, United States.

Abstract

Background: Recent data suggests clinically significant weight gain among non-pregnant HIV-positive adults after starting dolutegravir-based ART (DTG). Excess or insufficient weight gain in pregnancy could adversely impact pregnancy outcomes, but data for pregnant women receiving DTG are limited.

Methods: The Tsepamo Study captured data at delivery sites in Botswana from 2014 to 2019. HIV testing, HIV treatment information, and weight measurements during antenatal care were abstracted from the maternity obstetric record at delivery. HIV-positive women initiating DTG or efavirenz-based ART (EFV) between conception and 17 weeks gestation and HIV-uninfected women first presenting for antenatal care before 17 weeks gestation were included. We evaluated weekly weight gain, total 18-week weight gain, excess weight gain (>0.59 kg/week), insufficient weight gain (<0.18 kg/week), and weight loss between 18±2 and 36±2 weeks gestation, adjusting for demographic and clinical variables.

Findings: Baseline characteristics were similar by exposure group, including pre-pregnancy and early pregnancy weight. Compared with EFV, mean weekly weight gain between 18 and 36 weeks gestation was 0.05 (95% CI 0.03, 0.07) kg/week higher for women initiating DTG and 0.12 (0.10, 0.14) kg/week higher for HIV-uninfected women. Mean 18-week weight gain was 1.05 (95% CI 0.61, 1.49) kg higher for women initiating DTG and 2.31 (1.85, 2.77) kg higher for HIV-uninfected women, compared with EFV. Women initiating DTG were more likely to gain excess weight but less likely to gain insufficient weight or lose weight than women initiating EFV.

Interpretation: Women initiating DTG compared with EFV during pregnancy gained more weight between 18 and 36 weeks gestation. Neither group gained as much weight as HIV-uninfected women. Initiating DTG compared with EFV during pregnancy could increase the risk of excess weight gain but decrease the risk of insufficient weight gain and weight loss, which could have positive and negative consequences in pregnancy. Our findings are consistent with prior studies in non-pregnant adults.

Keywords: Botswana; Dolutegravir; Efavirenz; Pregnancy; Weight gain.

Abstract

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