O'Brien BE, Williams PL, Williams Y, et al. - From the Pediatric HIV/AIDS Cohort Study Surveillance Monitoring for Antiretroviral Treatment Toxicities (SMARTT) study between 2007 and 2018, women living with HIV (WLHIV) with ≥ 2 live-born infants were evaluated for associations of covariates with CD4 and viral suppression and the association of protease inhibitors (PIs)/integrase strand transfer inhibitors (INSTIs) use during pregnancy with odds of preterm birth. They identified 736 women with ≥ 2 live-born children (1,695 pregnancies). Over repeat pregnancies, median CD4 counts remained stable. Observations revealed achievement of VL suppression in most WLHIV by late pregnancy but there were many who were viremic early in subsequent pregnancies. A higher risk of preterm birth was observed in correlation with first trimester initiation of PIs or INSTIs.