Abstract
BackgroundHigh rates of adverse pregnancy outcomes globally raise the need to understand risk factors and develop preventative interventions. The Pregnancy Outcomes in the Era of Universal Antiretroviral Treatment in Sub-Saharan Africa (POISE Study) was a prospective, observational cohort study conducted from 2016 to 2017 in Blantyre, Malawi. We examine the associations between indicators of nutritional status, specifically mid-thigh circumference (MTC) and body-mass index (BMI), and adverse pregnancy outcomes, low birth weight (LBW), preterm birth (PTB), and small-for-gestational age (SGA), in a cohort of HIV-infected and HIV-uninfected women.MethodsSociodemographic, clinical, laboratory, and maternal height, weight and MTC data were collected immediately before or after delivery at the Queen Elizabeth Central Hospital (QEHC) and 4 affiliated health centers in Blantyre, Malawi. LBW was defined as birth weight < 2.5 kg; PTB as gestational age < 37 weeks using Ballard score; and SGA as birth weight < 10th percentile for gestational age. Descriptive, stratified, and multivariable logistic regression were conducted using R.ResultsData from 1298 women were analyzed: 614 HIV-infected and 684 HIV-uninfected. MTC was inversely associated with LBW (adjusted odds ratio [aOR] = 0.95, p = 0.03) and PTB (aOR 0.92, p < 0.001), after controlling for HIV status, age, socioeconomic status and hemoglobin. The association between MTC and SGA was (aOR 0.99, p = 0.53). Similarly, higher BMI was significantly associated with lower odds of PTB (aOR 0.90, p < 0.001), LBW (aOR 0.93, p = 0.05), and SGA (aOR 0.95, p = 0.04).ConclusionsWe observed an inverse relationship between MTC and adverse pregnancy outcomes in Malawi irrespective of HIV infection. MTC performs comparably to BMI; the ease of measuring MTC could make it a practical tool in resource-constrained settings for identification of women at risk of adverse pregnancy outcomes.
Highlights
High rates of adverse pregnancy outcomes globally raise the need to understand risk factors and develop preventative interventions
An observational study conducted among HIV-infected women in Tanzania demonstrated the usefulness of assessing maternal nutritional status using measurements such as mid-arm muscle area (MAMA) and mid-upper arm circumference (MUAC) to screen for adverse pregnancy outcomes of low birth weight (LBW), preterm birth (PTB), and small-for-gestational age (SGA)
Among HIV-infected women in Malawi, mid-upper arm circumference (MUAC), arm muscle area (AMA), and arm fat area (AFA) were all shown to be negatively associated with LBW [7]
Summary
High rates of adverse pregnancy outcomes globally raise the need to understand risk factors and develop preventative interventions. We examine the associations between indicators of nutritional status, mid-thigh circumference (MTC) and body-mass index (BMI), and adverse pregnancy outcomes, low birth weight (LBW), preterm birth (PTB), and small-for-gestational age (SGA), in a cohort of HIV-infected and HIV-uninfected women. Maternal nutrition impacts both the health of the mother and the child, raising the importance of assessing the nutritional status of pregnant women as part of prenatal care. An observational study conducted among HIV-infected women in Tanzania demonstrated the usefulness of assessing maternal nutritional status using measurements such as mid-arm muscle area (MAMA) and mid-upper arm circumference (MUAC) to screen for adverse pregnancy outcomes of LBW, PTB, and SGA. While MUAC and MAMA have been used as indicators of nutritional status, midthigh circumference (MTC) measurement has not been frequently assessed to determine associations between nutritional status and birth outcomes among HIVinfected and uninfected women
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