Balogun KA, et al. - This study was planned to investigate the association between protease inhibitor (PI)–based combination antiretroviral therapy (cART) and estradiol levels in pregnancy. As per observations, PI-cART exposure is associated with elevated levels of estradiol in pregnancy. This may be due to higher fetal dehydroepiandrosterone sulfate (DHEAS) production. In infants born to PI-cART–exposed women, cord estradiol levels had an inverse correlation with birth weight centile. Thereby suggesting that fetal exposure to high estradiol levels could have contributed to cART-associated fetal growth restriction.