Risk of birth defects is small with antiretroviral drugs taken during pregnancy, considering the benefits of preventing the transmission of HIV to the child.

Although limited by the absence of data on termination of pregnancy, stillbirths, tobacco and alcohol intake, and concomitant medication, the authors found a small increase in the risk for heart defects in children exposed to zidovudine using both classification systems (an absolute risk of +1.2%) and a possible association between efavirenz exposure and neurological defects, but only when using the MACDP classification system (an absolute risk of + 0.7%).
The authors found no association between several other antiretroviral drugs, including nevirapine (a drug in the NNRTI family, like efavirenz); tenofovir, stavudine, and abacavir (drugs in the NRTI family, like zidovudine); and lopinavir and ritonavir (drugs in the protease inhibitor family) and any type of birth defect.
The authors stress: "Whatever the impact that some [antiretroviral] drugs may have on birth defects, it is surpassed by the major role of [antiretroviral therapy] in the successful prevention of mother-to-child transmission of HIV."
In an accompanying Perspective, US experts Lynne Mofenson from the National Institutes of Health and Heather Watts from the Office of the Global AIDS Coordinator say: "While the Sibiude study raises some important questions, given the enormous benefits of maternal antiretroviral drugs, the unclear clinical significance of the heart defects and the lack of a specific pattern of CNS defects with efavirenz, no change in prescribing practices is indicated, but continued surveillance is critical."
Source-Eurekalert