Journal Article

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

Ruel, Theodore, Charlebois, Edwin, Havlir, Diane, Natureeba, Paul, Arinaitwe, Emmanuel, Achan, Jane, Mwesigwa, Julia, Osterbauer, Beth, Kamya, Moses, Young, Sera, Cohan, Deborah, Murray, Katherine, Plenty, Albert, Clark, Tamara, Ades, Veronica

2012

Overview

Maternal 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. Prospective cohort. HIV-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. Mean 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%. In 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. Clinicaltrials.gov NCT00993031.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adult / AIDS / Analysis / Anthropometry / Anti-HIV Agents - pharmacology / Anti-HIV Agents - therapeutic use / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Antiretroviral Therapy, Highly Active / Babies / Birth weight / Births / Body mass / Body mass index / Childbirth & labor / Children & youth / Collaboration / Disease prevention / Disease transmission / DNA polymerases / Drug dosages / Drug therapy / Female / Fetal Growth Retardation - pathology / Fetus - drug effects / Fetuses / Gestation / Gestational age / Glycosylated hemoglobin / Gynecology / Hemoglobin / Highly active antiretroviral therapy / HIV / HIV infections / HIV Infections - drug therapy / HIV patients / Human immunodeficiency virus / Humans / Infant, Low Birth Weight / Infant, Newborn / Infant, Small for Gestational Age / Infants / Laboratories / Low birth weight / Maternal Nutritional Physiological Phenomena - drug effects / Medicine / Mortality / Multivariate Analysis / Neonates / Newborn infants / Non-nucleoside reverse transcriptase inhibitors / Nutritional status / Nutritional Status - drug effects / Obstetrics / Pregnancy / Pregnancy Outcome / Pregnant women / Premature birth / Prognosis / Protease inhibitors / Proteases / Proteinase inhibitors / Risk Factors / RNA-directed DNA polymerase / Rural Population / Small for gestational age / Studies / Therapy / Uganda / Ultrasonic imaging / Weight Gain - drug effects / Womens health