# Decreasing Adverse Birth Outcomes among HIV-infected Women on Antiretroviral Therapy

> **NIH NIH K23** · BETH ISRAEL DEACONESS MEDICAL CENTER · 2020 · $164,376

## Abstract

Background Implementation of 3-drug antiretroviral therapy (ART) for prevention of mother to child
transmission of HIV (PMTCT) has dramatically decreased vertical transmission of HIV globally. However,
recent evidence suggests that women on ART have exceptionally high risk of stillbirth, preterm delivery and
small for gestational age infants. Though reasons for adverse birth outcomes are unknown, a growing number
of studies have found that hypertension is an important risk factor, leading us to hypothesize that maternal
endothelial dysfunction causes adverse birth outcomes among HIV-infected women on ART.
Candidate I first contributed to the field of PMTCT 16 years ago when I lived in South Africa and ran the first
local NGO to provide antiretroviral prophylaxis in pregnancy. I decided to pursue a research career in PMTCT
and adverse birth outcomes during my Infectious Diseases fellowship, after performing a large birth
surveillance study in Botswana that found strikingly high rates of adverse birth outcomes and hypertension
among women with well-controlled HIV. I am applying for a 5-year K23 Career Development Award that builds
on findings from my fellowship study. A K23 award will provide the necessary training and experience needed
to become an independent investigator studying drug safety in pregnancy, identifying mechanisms underlying
adverse birth outcomes and testing interventions to improve pregnancy outcomes among HIV-infected women.
Mentoring My primary mentor, Dr. Roger Shapiro, has conducted clinical trials, research on childhood
mortality, and birth outcomes research in Botswana for more than 15 years and has been my research mentor
since residency. Together we have identified an excellent mentoring team including Dr. Paige Williams (a
biostatistician with expertise in studies of drug safety in pregnancy) and Dr. Raina Fichorova (an OB/GYN with
20 years experience running a lab in obstetric immunology).
Research Using data collected in an ongoing large birth surveillance study in Botswana, and creating a nested
cohort within this surveillance study, my study will 1) establish the role of hypertension in adverse pregnancy
outcomes and 2) evaluate the role of low progesterone and chronic inflammation as mechanisms of adverse
birth outcomes. I will evaluate whether HIV-status, specific ART regimens and/or the timing of ART initiation
influence hypertension, progesterone level and markers of chronic inflammation. These combined analyses are
critical first steps in the design of a larger longitudinal cohort to further elucidate mechanisms of adverse birth
outcomes among HIV-infected women on ART. This will lead to interventions to improve birth outcomes
among HIV-infected women.
Training The research objectives are supported by a training plan that includes obtaining an MSc in
Epidemiology, further training in the pathophysiology of adverse birth outcomes and a grant support and
development program through Harvard Catalyst.

## Key facts

- **NIH application ID:** 9965990
- **Project number:** 5K23HD088230-04
- **Recipient organization:** BETH ISRAEL DEACONESS MEDICAL CENTER
- **Principal Investigator:** Rebecca Marie Zash
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $164,376
- **Award type:** 5
- **Project period:** 2017-07-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9965990

## Citation

> US National Institutes of Health, RePORTER application 9965990, Decreasing Adverse Birth Outcomes among HIV-infected Women on Antiretroviral Therapy (5K23HD088230-04). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9965990. Licensed CC0.

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