Background:  Data are scant on the effect of HAART on glucose metabolism in pregnant HIV-1-infected women. The aim of this study has been to estimate the prevalence of gestational diabetes in a cohort of HIV-1-infected women and to determine possible risk factors associated with the development of gestational diabetes in these women.

Methods:  A prospective cohort study was performed at 12 Spanish hospitals from Madrid and Barcelona. All mothers followed from 2000 to December 2003 were included. Patients were followed according to a standardized protocol. O’Sullivan test was carried at the second trimester (24 to 26 weeks).When it was abnormal, a subsequent glucose tolerance test was performed at 28 to 30 weeks. When 2 tests were abnormal, the diagnoses of gestational diabetes was established. Maternal characteristics and ART history were also registered. For analysis, ART-use throughout pregnancy was categorized as: monotherapy, bitherapy, HAART with protease inhibitor (PI), and HAART without PI. Logistic regression was used to adjust for known risk factors of gestational diabetes.

Results:  Among the 669 mothers enrolled, only 609 had regular visits during pregnancy during which glucose metabolism could be studied. Median age was 30.7 years (16 to 44); 16% were immigrants. Heterosexual contact was the main mode of HIV infection (67.4%); 71% were category A and 15% category C; 53% were co-infected with hepatitis C virus. Median CD4 and viral load at the third trimester were 545copies/mm³ (139 to 1690) and 1.9 log (1.7 to 5.4); 74% were treated with HAART (41% with PI, 32% without), 2.8% monotherapy, 5.6% bitherapy, 17.6% no therapy or  unknown. Of 609 women, 43 were diagnosed with gestational diabetes. Estimated prevalence was 7 % CI 95% (5.2 to 9.5). Risk factors significantly associated with gestational diabetes in univariate analysis included older age, hepatitis C co-infection, stavudine (d4T) and PI exposure. There were no significant differences in CD4 or viral load. Only older age (OR 1.9, CI 95% 1 to 1.18) and PI exposure (OR 2.3, CI 95% 1 to 5.3) remained as independent risk factors in multivariate analysis.

Conclusions:  In our cohort of HIV-1-infected women the prevalence of gestational diabetes appears to be increased compared to general population. Older age and PI exposure are independent significant risk factors for gestational diabetes.

Keywords: gestational diabetes; antiretroviral therapy ; HIV-1 infected women