LBPEB14

Title

Weight gain during pregnancy among women initiating dolutegravir in Botswana

Presenter

Ellen Caniglia

Authors

E. Caniglia^1,2, R. Shapiro^2,3, M. Diseko³, B. Wylie⁴, C. Zera⁴, S. Davey³, A. Isaacson³, G. Mayondi³, J. Mabuta³, R. Luckett⁴, J. Makhema³, M. Mmalane³, S. Lockman^3,5, R. Zash^3,4, The Tsepamo Study

Institutions

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

Background: Recent data suggests clinically significant weight gain among non-pregnant HIV-infected adults after starting dolutegravir-based ART (DTG). Excess or inadequate weight gain in pregnancy could adversely impact maternal and fetal outcomes, but data for pregnant women receiving DTG has been limited to date.
Methods: The Tsepamo Study captured data at up to 18 large delivery sites in Botswana from August 2014-March 2019. Pre-pregnancy weight, weight measurements during antenatal care (ANC), HIV testing and HIV treatment information were abstracted at delivery from the maternity obstetric record. HIV-positive pregnant women who initiated DTG or EFV between conception and 17 weeks gestation and HIV-negative women with similar ages who presented for ANC care before 17 weeks gestation were included in this analysis. We evaluated weekly weight gain and total 18-week weight gain between 18±2 and 36±2 weeks gestation by exposure group. Linear regression models estimated mean differences, adjusting for demographic and clinical variables.
Results: Women initiating DTG and EFV had similar baseline characteristics, including pre-pregnancy weight and weight at ART initiation. Compared to EFV, the adjusted mean weekly weight gain was 0.05 (95% CI 0.03, 0.07) kg/week higher and the adjusted mean 18-week weight gain was 1.12 (95% CI 0.67, 1.57) kg higher for DTG. The weight gains in both ART groups were less than the weight gains in HIV-negative women (Table). Differences in weight gain by ART regimen were larger among women weighing >80kg and were attenuated among women weighing < 50kg before ART initiation.

	EFV (n=1,683)	DTG (n=1,464)	HIV-negative (n=21,917)
Age, mean	28.8	28.9	28.3
Pre-pregnancy weight, mean	62.60kg	62.80kg	63.01kg
Weight at ART initiation, mean	65.62kg	65.66kg	66.51kg (at first ANC)
Primigravid, percent	29.1%	26.6%	32.7%
Pre-ART CD4 cell count, mean	419 cells/µl	390 cells/µl	--
Weekly weight gain, mean	0.31kg/week	0.35kg/week	0.44kg/week
Adjusted mean difference (95% CI)	reference	0.05 (0.03, 0.07) kg/week	0.12 (0.10, 0.15) kg/week
18-week weight gain, mean	5.30kg	6.27kg	7.95kg
Adjusted mean difference (95% CI)	reference	1.12 (0.67, 1.57) kg	2.42 (1.92, 2.91) kg

[Baseline characteristics and weight gain during pregnancy by exposure group, The Tsepamo Study]

Conclusions: Women initiating DTG compared with EFV during pregnancy gained more weight between 18 and 36 weeks gestation, particularly among those with higher pre-ART pregnancy weight. However, neither group gained as much weight as HIV-negative women. Further research is needed to understand the impact of weight gain differences on maternal and infant outcomes.

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