Maternal HIV Infection, but not Food Insecurity, Predicts the Pattern of Weight Gain in Pregnant Women Attending Antenatal Services in Northern Uganda

Abstract

In Sub-Saharan Africa, the differential impact of maternal HIV infection and/or food insecurity on the pattern of weight gain among pregnant women is unknown. To fill this gap, data on 402 pregnant women (33% HIV+ & participating in antiretroviral treatment) enrolled in a perinatal cohort study at Gulu Regional Referral Hospital in northern Uganda were analyzed. We used mixed effects models with gestational age at each assessment as the time variable to determine the influence of HIV and/or food insecurity on the rate of, and cumulative, weight gain during pregnancy. Between 10 and 42 weeks of gestation, the unadjusted rate of weight gain among HIV+ women was 308.2±10.6g/week compared to 238.3 ± 14.9g/week for HIV uninfected women (mean±s.e; p<0.001). After adjusting for maternal age and height, HIV infection, but not food insecurity, was associated with weight gain in pregnancy. The adjusted rate of weight gain was 51g/week lower among HIV+ women than HIV- women (p=0.01). Weight gain rates among HIV+ women were lowest (-85g/week, p=0.008) during weeks 33 to 42 of gestation. After controlling for women's duration of stay in the study, HIV+ women gained about 1.09kg less weight than HIV- women (p<0.001). To develop and target interventions for improving weight gain among pregnant women of mixed HIV status, there is need to understand the mechanisms by which HIV-infected pregnant women gain less weight than HIV-uninfected women.