Dolutegravir, Pregnancy, and Neural Tube Defects: Benefits Still Outshine Risks

Is dolutegravir safe for women of reproductive age to use? Following a potential concern due to increased risk for neural tube defects in the offspring of women who received dolutegravir-based antiretroviral therapy at conception (NEJM JW Infect Dis Aug 2018 and Lancet Glob Health 2018 Jul; 6:e804; [e-pub]), investigators in Botswana prospectively evaluated almost 120,000 more deliveries for adverse birth outcomes with a focus on neural tube defects identified with neonatal surface examination.

Neural tube defects occurred in 0.3% of infants born to 1683 women who received dolutegravir at conception, 0.1% of infants of 14,792 women who received antiretrovirals without dolutegravir, 0.04% of infants of 7959 women who received efavirenz, and 0…