Antiretrovirals up gestational diabetes risk: small study

OB/GYN News, Dec 15, 2003 by Damian McNamara

SANTIAGO, CHILE -- Treatment of HIV-positive women with protease inhibitors during pregnancy was associated with an increased risk for gestational diabetes in a small study.

An association between long-term use of protease inhibitors and onset of diabetes mellitus has been found in people with HIV infection. But whether use of the agents during the relatively shorter time frame of pregnancy can trigger gestational diabetes is unknown, Dr. Geraldo Duarte said at the FIGO World Congress of Gynecology and Obstetrics.

He and his colleagues enrolled a total of 44 pregnant women in a prospective study at the tertiary hospital of the University of Sao Paulo (Brazil). One group of 16 women received only zidovudine, and another 16 women received triple therapy with zidovudine, lamivudine, and nelfinavir. Twelve HIV-negative women served as controls.

Treatment began at 14-16 weeks' gestation. Demographics were similar among the groups. Obese patients and women with a personal or family history of diabetes mellitus were excluded.

"Antiretroviral medications avoid vertical transmission of HIV ... but there are some adverse effects," Dr. Duarte of the Medical School of Ribeirao Preto, Sao Paulo, said in an interview.

To assess whether gestational diabetes is one of those effects, a 75-gram oral glucose tolerance test was performed at 14-20 weeks, 21-26 weeks, 27-32 weeks, and 33-38 weeks of pregnancy. Glucose levels were measured at 2 hours, and values for area under the curve were used to diagnose gestational diabetes.

The median area under the curve did not differ significantly among the groups before 32 weeks. At the final measurement, however, the result was 12,450 mg/dL for the zidovudine group, 13,912 mg/dL for the triple-therapy group, and 11,685 mg/dL for controls. Two of the 12 women in the triple-therapy group (17%) developed gestational diabetes; none of the women in the zidovudine or control groups developed diabetes.

Protease inhibitors during pregnancy appears to predispose patients to gestational diabetes. "When you follow people who use triple therapy for a long, long time, we know it can cause diabetes. This is the first time it was seen during pregnancy, that diabetes could be provoked within 40 weeks," Dr. Duarte said.