Maternal Nutritional Status Predicts Adverse Birth Outcomes among HIV-Infected Rural Ugandan Women Receiving Combination Antiretroviral Therapy

Abstract

ObjectiveMaternal nutritional status is an important predictor of birth outcomes, yet little is known about the nutritional status of HIV-infected pregnant women treated with combination antiretroviral therapy (cART). We therefore examined the relationship between maternal BMI at study enrollment, gestational weight gain (GWG), and hemoglobin concentration (Hb) among 166 women initiating cART in rural Uganda.DesignProspective cohort.MethodsHIV-infected, ART-naïve pregnant women were enrolled between 12 and 28 weeks gestation and treated with a protease inhibitor or non-nucleoside reverse transcriptase inhibitor-based combination regimen. Nutritional status was assessed monthly. Neonatal anthropometry was examined at birth. Outcomes were evaluated using multivariate analysis.ResultsMean GWG was 0.17 kg/week, 14.6% of women experienced weight loss during pregnancy, and 44.9% were anemic. Adverse fetal outcomes included low birth weight (LBW) (19.6%), preterm delivery (17.7%), fetal death (3.9%), stunting (21.1%), small-for-gestational age (15.1%), and head-sparing growth restriction (26%). No infants were HIV-infected. Gaining <0.1 kg/week was associated with LBW, preterm delivery, and a composite adverse obstetric/fetal outcome. Maternal weight at 7 months gestation predicted LBW. For each g/dL higher mean Hb, the odds of small-for-gestational age decreased by 52%.ConclusionsIn our cohort of HIV-infected women initiating cART during pregnancy, grossly inadequate GWG was common. Infants whose mothers gained <0.1 kg/week were at increased risk for LBW, preterm delivery, and composite adverse birth outcomes. cART by itself may not be sufficient for decreasing the burden of adverse birth outcomes among HIV-infected women.Trial RegistrationClinicaltrials.gov NCT00993031

“I Have Remained Strong Because of That Food”: Acceptability and Use of Lipid-Based Nutrient Supplements Among Pregnant HIV-Infected Ugandan Women Receiving Combination Antiretroviral Therapy

“…Reported possession of six household assets were used as a proxy for wealth. Anthropometric data, including maternal height and weight, gestational age, obstetric outcomes and infant birthweight were collected in the parent study, as described elsewhere [11]. …”

“…Nutrient deficiencies, in turn, have demonstrable deleterious health consequences in both pregnant [4] and HIV-infected populations [5,6]. The observed sequelae of poor nutrition during pregnancy among HIV-infected populations includes a range of adverse maternal, obstetric and infant health outcomes, including a potential increased risk of vertical transmission [7–11]. …”

“…Further, low GWG (< 0.1 kg/week) was associated with increased risk for low birthweight (LBW), preterm delivery, and composite adverse birth outcomes [11]. Because nutritional status is a major modifiable determinant of both maternal and infant health [12–14] and poor nutritional status is common among many HIV-infected many pregnant women [7–11], we sought to offer a supplementation regimen to our pregnant participants that would be appropriate for increasing weight gain.…”

Maternal post-absorptive leucine kinetics during late pregnancy in US women with HIV taking antiretroviral therapy: A cross-sectional pilot study

“…Studies examining the effect of HIV/cART on infant birth weight have been conflicting(5, 6, 41, 42). In studies demonstrating lower birth weight in infants born to HIV(+) women, low maternal CD4 count and high viral load were variables associated with this adverse outcome(43–45); associations not seen in our cohort.…”

“…Combination antiretroviral treatment (cART) is effective in preventing the vertical transmission of Human Immunodeficiency Virus (HIV) from mother to child during pregnancy and parturition (2–4). However children exposed to cART in utero , regardless of their HIV status appear to be at a greater risk for lower birth weight (5, 6) and stunted growth and wasting(7, 8), particularly in less developed countries. In addition, children exposed to cART in utero are born with minor cardiac abnormalities (9) that persist into pre-adolescence (10).…”