Factors associated with insufficient weight gain among Mexican pregnant women with HIV infection receiving antiretroviral therapy.

Estela Godínez,Cristina Ramírez,Maricruz Tolentino,Ricardo Figueroa,Rosa María Morales,Mayra Chávez-Courtois,Diana M Thomas

doi:10.1371/journal.pone.0233487

Estela Godínez, Cristina Ramírez + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0233487

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Journal: PloS one	Publication Date: May 22, 2020
Citations: 2	License type: CC BY 4.0

Affiliation: Instituto Nacional de Perinatología

Abstract

We identified clinical, dietary, and socioeconomic factors associated with insufficient gestational weight gain among Mexican pregnant women with human immunodeficiency virus (HIV) infection. This was a cross-sectional study involving 112 pregnant women with HIV infection receiving antiretroviral therapy (ART). Data including viral load, complete blood analysis, and CD4 counts were extracted from medical records. An inquiry form was used to collect data on socioeconomic status and frequency of food intake. Pre-gestational weight was calculated based on pregnancy weight to obtain the body mass index (BMI) and weight gain for gestational age according the US Institute of Medicine. Of the study population, 68.7% were in consensual union, 31.3% were single, and 33.9% belonged to the two lowest socioeconomic strata. The median age and CD4 count were 27 (interquartile range [IQR]: 23-32) years and 418 (IQR: 267-591), respectively. The adequacy of energy was 91.8% (IQR: 74.1-117.7). The median energy intake from protein was 13.5% (IQR: 12.2-14.9) and from lipids, 35.5% (IQR: 31.1-40.3). Pregnant women with gastrointestinal symptoms and CD4 count <350 were seven times more likely to have folate deficiency (odds ratio [OR] 7.8, 95% confidence interval [CI] 1.6-38.1; p = 0.009) and six times more likely to have poor zinc intake (OR 6.7, 95% CI 1.3-36.8; p = 0.014). In all, 42.9% of the pregnant women consumed iron and folic acid supplements and 54.4% consumed multivitamin supplements. Moreover, 45.5% had a normal pre-gestational BMI, 41.1% were classified overweight, and 13.4% had obesity, whereas 62.5% showed insufficient gestational weight gain, and 18.8% experienced weight loss. The variables associated with insufficient weight gain were consensual union (OR 5.3, 95% CI 1.9-15.0; p = 0.002) and belonging to the lowest socioeconomic stratum (E) (OR 3.1, 95% CI 1.0-9.2; p = 0.046). Dietary strategies to improve gestational weight gain for Mexican women with HIV infection receiving ART must consider clinical and socioeconomic factors.

Highlights

Pregnancy increases energy and nutrient requirements which are necessary to provide a healthy intrauterine environment, allowing the optimal development of the fetus [1]
Dietary, and socioeconomic factors associated with insufficient gestational weight gain among Mexican pregnant women with human immunodeficiency virus (HIV) infection
It is well-known that this is unlikely to affect gestational weight gain in women who are HIV seropositive living in developed countries, more research is needed among HIV seropositive pregnant women in developing countries who often experience poverty [2] because a large proportion of them live in economic detriment, isolation and social stigmatization resulting in food insecurity[4]

Summary

Introduction

Pregnancy increases energy and nutrient requirements which are necessary to provide a healthy intrauterine environment, allowing the optimal development of the fetus [1]. Food intake can be affected by HIV infection, the existence of opportunistic infections and the secondary effects of treatment such as nausea, vomiting, diarrhea, and alterations in taste and smell [3] It is well-known that this is unlikely to affect gestational weight gain in women who are HIV seropositive living in developed countries, more research is needed among HIV seropositive pregnant women in developing countries who often experience poverty [2] because a large proportion of them live in economic detriment, isolation and social stigmatization resulting in food insecurity[4]. The dynamics of the domestic unit are based on gender and age, cooperative relationships, and the power exchange and conflict that are continuously being established around the division of labor and decision making [7] These dynamics can affect the diet of family members both by gender and age [8]. All the above-mentioned factors can result in insufficient gestational weight gain which may lead to an increase in maternal and neonatal morbidities in both the short- and long-term [11,12]

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