A new study conducted in South Africa has found that pregnant women living with human immunodeficiency virus (HIV) who receive antiretroviral therapy (ART) experience foetal growth patterns comparable to those of HIV-negative women.
The findings, published in AIDS, offer vital reassurance for women globally and support current international health guidelines. Results were recently presented at the IAS 2025 Conference on HIV Science, held in Kigali, Rwanda.
Pregnant women with HIV are at increased risk of delivering babies that are small for gestational age (SGA), defined as a birthweight below the 10th centile, corrected for gestational age. These babies are at increased risk of neonatal death and impaired growth and development in later life.
Led by researchers from the University of Oxford, the University of the Witwatersrand, University of Southampton, and the London School of Hygiene & Tropical Medicine, the study is the largest to date to investigate foetal growth trajectories in women with HIV using high-quality ultrasound data.
Over 600 pregnant women were enrolled at Chris Hani Baragwanath Academic Hospital in Soweto, South Africa, between 2013 and 2016. Of these, 228 were living with HIV. Each participant had up to five ultrasound scans during their pregnancy to record key foetal growth measurements including head circumference, biparietal diameter (a measurement of the foetal head), abdominal circumference, and femur length.
Key findings:
- There were no significant differences in foetal growth or the speed of growth between women living with HIV and HIV-negative women.
- There was no significant association between maternal HIV infection and in-utero SGA or very SGA (<3rd centile for gestational age).
- Findings remained consistent when limited to women receiving efavirenz-based ART, the standard treatment at the time.
In 2024, 40.8 million people were living with HIV globally, with most in sub-Saharan Africa. 84% of pregnant women with HIV in sub-Saharan Africa receive ART. The treatment allows those living with HIV to lead long, healthy lives, and significantly reduces the risk of transmitting the virus to others. This includes stopping HIV from being passed from a mother with HIV to her baby during pregnancy, childbirth, or breastfeeding.
Sub-Saharan Africa continues to carry the highest burden of HIV and neonatal mortality. The intersection of these public health challenges has raised concerns about the possible effects of HIV and ART on foetal development. Our data show that with appropriate treatment, maternal HIV infection does not affect foetal growth negatively.
- Dr Dhruv Darji, a former MSc student in Global Health Science & Epidemiology and lead author of the study
This study addresses a critical evidence gap by using accurate gestational dating and repeated ultrasound measurements – methodological strengths that have been lacking in previous research.
Professor Joris Hemelaar, joint senior author, commented ‘Our results provide reassurance that efavirenz-based ART, widely used in low-resource settings, does not compromise foetal growth. This reinforces the current global health guidelines, which recommend ART for pregnant women with HIV, not only to keep the mother healthy but also to help prevent passing HIV to the baby.’
The researchers emphasise the need for further studies on newer ART regimens, such as dolutegravir-based therapies, which are now increasingly recommended as the first-line treatment for pregnant women.
The study was funded by the Gates Foundation. Data are available on request to the INTERBIO-21st Consortium.