Perinatal Exposure to Aflatoxins is Associated with a Lower Rate of Weight Gain Among HIV‐Infected Pregnant Women and Reduced Linear Growth of HIV‐Exposed Infants

Abstract

Aflatoxins (AF) are carcinogens associated with poor linear growth in infants. AF serum levels have been reported to be higher in HIV infected (+) women. However, it is not known if maternal AF exposure affects gestational weight gain (GWG), or if relationship between in utero AF exposure and changes in perinatal anthropometry differs by maternal HIV or infant HIV exposure status. We enrolled 403 pregnant women (33.3% HIV (+), all on anti-retroviral treatment) at the antenatal clinic of Gulu Hospital, northern Uganda. At enrollment and 1 month postpartum, a serum sample was collected from women and stored at −80°C until tested for aflatoxin B1 lysine-adduct levels (AFB1) using HPLC-fluorescence. Women's weight was measured at enrollment and monthly thereafter. 246 dyads were recruited into a postnatal cohort and infant anthropometrics were measured at 1, 3, 6, 9 and 12 months. Indicators of linear growth (height for age, HAZ) were calculated using the 2006 WHO standards. We assessed (1) if gestational AF exposure predicted GWG, and (2) if perinatal AF exposure was related to HAZ growth in 1–12 month old infants. The mean (±SD) enrollment gestational age was 19.4 (±−3.8) weeks. At that time, the mean AFB1 level for HIV (−) women was 6.5 (±13.8) pg/mg albumin vs 37.6 (±82.8) for HIV (+) women (p<0.001). 1 month after birth, AFB1 levels for HIV (−) women were 8.8 (24.3) vs 113.9 (100.6) in HIV (+) women (p<0.001). Using a cut-off of perinatal AFB1=5.47pg/mg of albumin, 59% of early postpartum women met the criteria of being in the high AF category. In bivariate models, the rate of GWG was 308 (±333.6) g/wk for HIV (−) vs 247 (±399) g/wk among HIV (+) women (p=0.003). Adjusting for gestational age, food insecurity, dietary diversity, and asset index, a one log increase in gestational serum AF was associated with 26.1 g/wk less GWG in HIV (+) women (p=0.016). We found no significant association between gestational AF exposure and GWG in the HIV (−) group (Figure 1). Postnatally, adjusting for prenatal food insecurity, dietary diversity, asset index, and infant age and gender, infants of HIV (+)women in the high perinatal AF category had 0.460 lower HAZ scores than infants of HIV (−) women in the low AF exposure category (p=0.006) (Figure 2). Our results suggest that aflatoxin exposure negatively affects maternal nutrition (GWG) and infant linear growth (HAZ) in HIV (+) pregnant women and their HIV-exposed infants. Support or Funding Information This research was funded in part by Cornell University-Weill Medical College Inter-campus Seed Funds, K01 MH098902 from NIMH and USAID Cooperative Agreement AID-OAA-L-10-00006 Figure 1Open in figure viewerPowerPoint Rate of weight gain (kg/week) during pregnancy by women's HIV and Aflatoxin Exposure Status (±1S.E.) Figure 2Open in figure viewerPowerPoint 1- to-12-month-old infant HAZ scores by their mothers HIV and aflatoxin exposure status (±1S.E.)