Elevated body mass index during pregnancy and gestational weight gain in HIV‐infected and HIV‐uninfected women in Cape Town, South Africa: association with adverse birth outcomes

Madlala, Hlengiwe P.; Malaba, Thokozile R; Newell, Marie‐Louise; Myer, Landon

doi:10.1111/tmi.13387

Cited by 16 publications

(21 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Maternal obesity was associated with increased likelihood of having high birthweight and large size for gestational age infants. In the subset cohort, GWG was associated with increased likelihood of spontaneous PTD and high birth weight infants 26 . Obesity during pregnancy is prevalent in this setting and appears associated with increased risk of adverse birth outcomes in both HIV-infected and -uninfected women.…”

Section: Findings To Datementioning

confidence: 90%

Cohort Profile: Prematurity Immunology in HIV-infected Mothers and their infants Study (PIMS)

Malaba

Gray²,

Myer

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Purpose: PIMS, is a prospective cohort study in South Africa investigating the association between antiretroviral therapy (ART) use, preterm delivery (PTD) and small-for-gestational age (SGA) live births. PIMS main hypotheses are that ART initiation in pregnancy and ART-induced hypertension are associated with PTD and SGA respectively and that reconstitution of cellular immune responses in women on ART from before pregnancy results in increases in PTD of appropriate-for-gestational age (AGA) infants. Participants: Pregnant women (n=3972) aged >18 years regardless of HIV status recruited from 2015 to 2016 into the overall PIMS cohort (2517 HIV-uninfected, 1455 HIV-infected). A nested cohort contained 551 HIV-infected women who were <24 weeks GA on ultrasound: 261 initiated ART before pregnancy, 290 initiated during pregnancy. Findings to date: Women in the overall cohort were followed antenatally through to delivery using routine clinical records; further women in the nested cohort were actively followed up until 12 months postpartum, with data were collected on maternal health (HIV care and ART use, clinical care and inter-current clinical history). Other procedures conducted on the nested cohort included physical examinations (anthropometry, blood pressure measurement), assessment of fetal growth (ultrasound), maternal and infant phlebotomy for storage of plasma, RNA and peripheral blood mononuclear cells, collection of delivery specimens (placenta and cord blood), and infant 12-month developmental assessment. Preliminary findings have contributed to our understanding of risk factors for adverse birth outcomes, and the relationship between pregnancy immunology, HIV/ART and adverse birth outcomes. Future plans: Using specimens collected from HIV-infected study participants throughout pregnancy and first year of life, the PIMS provides a valuable platform for answering a variety of research questions focused on temporal changes of immunology markers in women whose immune status is altered by HIV infection, and how ART initiated during pregnancy affects immune responses. The relationship between these immunological changes with adverse birth outcomes as well as possible longer-term impact of exposure to ART in fetal and early life will be explored. Additionally, further active and passive follow-up of mothers and their infants is planned at school-going age and beyond to chart growth, morbidity and development, as well as changes in family circumstances.

show abstract

Section: Findings To Datementioning

confidence: 90%

Cohort Profile: Prematurity Immunology in HIV-infected Mothers and their infants Study (PIMS)

Malaba

Gray²,

Myer

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, factors specific to HIV infection and treatment regimens have also been implicated in influencing the vulnerability of people living with HIV to increased obesity [ 43 ]. Despite the growing number of studies reporting obesity in women with HIV in the general population [ 3 , 5 , 44 , 45 ], there are limited data on GWG trends in this group. One South African study reported that women with HIV experience greater inadequate GWG [ 39 ], however, we found high prevalence of excessive GWG in our cohort.…”

Section: Discussionmentioning

confidence: 99%

“…In South Africa, almost 70% of women over 15 years are overweight/obese, the highest prevalence in sub-Saharan Africa (SSA) [ 1 ]. Consequently, over 40% of pregnant women are obese at antenatal care (ANC) entry, including those living with human immunodeficiency virus (HIV) on lifelong antiretroviral therapy (ART) [ 2 – 5 ]. Abundant data show that maternal obesity is associated with metabolic complications in pregnancy, which later increase the risk of a range of NCDs during postpartum period [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Association between food intake and obesity in pregnant women living with and without HIV in Cape Town, South Africa: a prospective cohort study

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background Although global nutrition/dietary transition resulting from industrialisation and urbanisation has been identified as a major contributor to widespread trends of obesity, there is limited data in pregnant women, including those living with HIV in South Africa. We examined food-based dietary intake in pregnant women with and without HIV at first antenatal care (ANC) visit, and associations with maternal overweight/obesity and gestational weight gain (GWG). Methods In an urban South African community, consecutive women living with (n = 479) and without (n = 510) HIV were enrolled and prospectively followed to delivery. Interviewer-administered non-quantitative food frequency questionnaire was used to assess dietary intake (starch, protein, dairy, fruits, vegetables, legumes, oils/fats) at enrolment. Associations with maternal body mass index (BMI) and GWG were examined using logistic regression models. Results Among women (median age 29 years, IQR 25–34), the prevalence of obesity (BMI ≥ 30 kg/m2) at first ANC was 43% and that of excessive GWG (per IOM guidelines) was 37% overall; HIV prevalence was 48%. In women without HIV, consumption of potato (any preparation) (aOR 1.98, 95% CI 1.02–3.84) and pumpkin/butternut (aOR 2.13, 95% CI 1.29–3.49) for 1–3 days a week increased the odds of overweight/obesity compared to not consuming any; milk in tea/coffee (aOR 6.04, 95% CI 1.37–26.50) increased the odds of excessive GWG. Consumption of eggs (any) (aOR 0.52, 95% CI 0.32–0.86) for 1–3 days a week reduced the odds of overweight/obesity while peanut and nuts consumption for 4–7 days a week reduced the odds (aOR 0.34, 95% CI 0.14–0.80) of excessive GWG. In women with HIV, consumption of milk/yoghurt/maas to drink/on cereals (aOR 0.35, 95% CI 0.18–0.68), tomato (raw/cooked) (aOR 0.50, 95% CI 0.30–0.84), green beans (aOR 0.41, 95% CI 0.20–0.86), mixed vegetables (aOR 0.49, 95% CI 0.29–0.84) and legumes e.g. baked beans, lentils (aOR 0.50, 95% CI 0.28–0.86) for 4–7 days a week reduced the odds of overweight/obesity; tomato (raw/cooked) (aOR 0.48, 95% CI 0.24–0.96) and mixed vegetables (aOR 0.38, 95% CI 0.18–0.78) also reduced the odds of excessive GWG. Conclusions Diet modification may promote healthy weight in pregnant women living with and without HIV.

show abstract

“…Although macrosmia has been associated with shoulder dystocia, neonatal and maternal trauma, [49] hypogycaemia, [50] this was not observed in our larger PIMS cohort when we stratified the groups by time of ART initiation (before versus during pregnancy). [51]…”

Section: Discussionmentioning

confidence: 99%

Associating antiretroviral therapy initiated before or during pregnancy with placenta pathology in HIV infected women

Ikumi

Malaba

Pillay

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Antiretroviral therapy (ART) is universally recommended for all HIV-infected pregnant women to improve survival and to reduce mother-to-child HIV transmission. With widespread use of ART in areas of high HIV prevalence, there is concern that prolonged in-utero ART exposure may result in adverse birth outcomes, such as preterm delivery and low birthweight infants. Underlying drivers of these effects may be found in the placenta. We examined whole placentas from live births to seek an association between timing of ART initiation and pregnancy outcome. This was a nested sub-study in a larger cohort of HIV-infected women recruited in a large primary care antenatal clinic in Cape Town, South Africa. Whole placentas (n=130) were collected at delivery and examined for histopathology from two ART groups. The stable group (n=53) initiated ART prior to pregnancy and the initiating group (n=77) started ART at a median of 15 weeks gestation. Adverse birth outcomes were defined by preterm delivery (PTD n=9), small-for-gestational age (SGA n=12) and low birthweight (LBW n=11) in the two groups. Wilcoxon rank-sum and t-tests were used to measure differences in placental histopathology by ART group. Binomial and univariate linear regression models, chi-squared or Fishers exact test were used to quantify associations between placenta histopathology and maternal factors including ART timing and the association with pregnancy outcome. Women in the stable group were significantly older (median [IQR] 33 years [28 - 37] vs 28 [25 - 32]; p=0.003), had higher CD4 cell counts 455 cells/ml [381 - 602] vs 369.5 [251 - 534.5], p=0.04) and were less likely to be prehypertensive or hypertensive at first antenatal care visit (p=0.03) than women in the initiating group. Overall, 119 (91%), women were on a fixed dose regimen of Tenofovir (TDF) + Lamivudine (3TC) + Efavirenz (EFV) and only 3 (2%; all in the stable group) were on a protease inhibitor (PI)-based regimen with no difference between the groups. Overall, nearly a third of placentas were small, although the fetal-placenta weight ratio was in the normal range for most women. Meconium exposure and chorioamnionitis was seen in 19% and 15% of placentas, respectively. Apart from maternal vascular malperfusion (MVM) and decidual arteriopathy, histopathology observations did not differ significantly between stable and initiating groups. Placentas from the stable group showed increased MVM (39.6% vs 19.4%, p=0.01) and decidual arteriopathy (11.3% vs 1.3%, p=0.02), with a trend of decreased placental weight (392g vs 422g, p=0.09). MVM, in turn, was significantly associated with PTD and LBW (p=0.002 and p<0.0001) and association with SGA was borderline significant (p=0.09). ART initiation prior to pregnancy was associated with an increased risk of maternal vascular malperfusion and decidual arteriopathy, suggestive of placental dysfunction. The association between MVM with PTD and LBW suggests that a placenta-mediated mechanism may link the putative association between ART and adverse birth outcomes.

show abstract

Elevated body mass index during pregnancy and gestational weight gain in HIV‐infected and HIV‐uninfected women in Cape Town, South Africa: association with adverse birth outcomes

Cited by 16 publications

References 47 publications

Cohort Profile: Prematurity Immunology in HIV-infected Mothers and their infants Study (PIMS)

Cohort Profile: Prematurity Immunology in HIV-infected Mothers and their infants Study (PIMS)

Association between food intake and obesity in pregnant women living with and without HIV in Cape Town, South Africa: a prospective cohort study

Associating antiretroviral therapy initiated before or during pregnancy with placenta pathology in HIV infected women

Contact Info

Product

Resources

About