LAUSR

OBJECTIVE We evaluated GWG in pregnant PLHIV enrolled in the Surveillance Monitoring for ART Toxicities study. DESIGN This was a cohort study. METHODS GWG was classified as excessive, adequate, or inadequate; weekly GWG in 2nd and 3rd trimesters was calculated using National Academy of Medicine standards. Adjusted modified Poisson and linear regression models were fit with generalized estimating equations to assess the association of antiretroviral treatment (ART) with GWG outcomes stratified by timing of ART initiation [at conception (ART-C) and initiating during pregnancy (ART-I)]. RESULTS We included 1477 pregnancies (847 ART-C, 630 ART-I) from 1282 PLHIV. The proportion of excessive, adequate, and inadequate GWG was 44%, 24%, and 32% respectively. No associations of ART class with excessive GWG were observed overall. However, among ART-I pregnancies with overweight pre-pregnancy body mass index (BMI), protease inhibitor (PI)-, non-nucleoside reverse transcriptase inhibitor-, and nucleoside reverse transcriptase inhibitor-based ART were associated with significantly lower GWG per week than integrase inhibitor (INSTI)-based ART [mean differences: -0.14, -0.27, and -0.29 kg/wk respectively]. Among ART-I pregnancies with obese pre-pregnancy BMI, lower weekly GWG was also observed for PI- vs. INSTI-based ART (mean difference: -0.14 kg/wk). CONCLUSION ART class type was not associated with excessive GWG. However, PLHIV entering pregnancy already overweight/obese and initiating INSTI-based ART had higher weekly GWG in 2nd and 3rd trimesters vs. other ART classes. Further studies to understand how increases in weekly GWG for overweight/obese PLHIV impinges on long-term maternal/child health are warranted.