Abstract
ObjectivesBoth maternal HIV infection and antiretroviral therapy are associated with adverse birth outcomes. The role of antenatal nutrient supplements with regard to adverse birth outcomes in HIV infected women exposed to antiretroviral therapy is not well known. We assessed the association between HIV and birth outcomes and explored whether antenatal lipid-based nutrient supplements (LNS) modulated this association.MethodsWe analysed a nested cohort of pregnant Malawian women who received daily LNS, multiple micronutrients (MMN) or iron and folic acid (IFA). Birth weight, length-for-age z-score (LAZ) and weight-for-age z-score (WAZ) were analysed as continuous outcomes and proportion of stunting and small-for-gestational age (SGA) as dichotomous outcomes.Results134 HIV infected (46 LNS, 39 MMN, 49 IFA) and 833 HIV uninfected (271 LNS, 287 MMN, 275 IFA) women were included. Maternal HIV infection was associated with a lower mean birth weight (-129g (-209, -48), P = 0.002); LAZ (-0.34 (-0.54, -0.13), P = 0.002) and WAZ (-0.21 (-0.40, -0.02), P = 0.041) and a higher risk of stunting (RR (95% confidence interval), 1.87 (1.24, 2.83), P = 0.003) and SGA (1.66 (1.21, 2.26), P = 0.001) in the newborn. If the women received LNS, HIV was not associated with LAZ (mean difference (95%); -0.02 (-0.35, 0.31), P = 0.918) or newborn stunting (RR (95% CI), 0.84 (0.34, 2.03), P = 0.691). However HIV tended to be associated with LAZ if the women received MMN (-0.42 (-0.80, -0.03), P = 0.053); and was significantly associated with LAZ if the women received IFA (-0.52 (-0.89, -0.14), P = 0.021) and with newborn stunting if they received MMN (2.40 (1.15, 4.98), P = 0.029) or IFA (2.40 (1.26, 4.59), P = 0.024).ConclusionsFurther research to investigate the impact of LNS on various aspects of foetal growth in HIV infected women is warranted.
Highlights
Global estimates indicate that 17.8 million women aged >15 years were living with human immunodeficiency virus (HIV) in 2016 [1]
Maternal HIV infection was associated with a lower mean birth weight (-129g (-209, -48), P = 0.002); length-for-age z-score (LAZ) (-0.34 (-0.54, -0.13), P = 0.002) and weight-for-age z-score (WAZ) (-0.21 (-0.40, -0.02), P = 0.041) and a higher risk of stunting (RR (95% confidence interval), 1.87 (1.24, 2.83), P = 0.003) and small-for-gestational age (SGA) (1.66 (1.21, 2.26), P = 0.001) in the newborn
HIV tended to be associated with LAZ if the women received multiple micronutrients (MMN) (-0.42 (-0.80, -0.03), P = 0.053); and was significantly associated with LAZ if the women received iron and folic acid (IFA) (-0.52 (-0.89, -0.14), P = 0.021) and with newborn stunting if they received MMN (2.40 (1.15, 4.98), P = 0.029) or IFA (2.40 (1.26, 4.59), P = 0.024)
Summary
Global estimates indicate that 17.8 million women aged >15 years were living with human immunodeficiency virus (HIV) in 2016 [1]. Maternal HIV continues to be associated with adverse birth outcomes such as preterm birth (PTB) and low birth weight (LBW) even in the context of ART use [3]. Different aspects of maternal ART including timing of initiation of therapy (pre-conception vs post-conception) or type of antiretroviral regimen have been reported to influence the risk of adverse birth outcomes in HIV infected women [4,5]. Low body-mass-index (BMI), low mid upper arm circumference (MUAC) and low gestational weight gain (GWG) have been identified as risk factors for PTB and FGR in HIV infected women [6,7,8]. Considering this knowledge, antenatal provision of dietary supplements that may improve maternal nutritional status or reduce oxidative stress may prevent the occurrence of these adverse birth outcomes
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