Abstract
Objective: Human immunodeficiency virus (HIV) infection is the most important chronic health condition among women in childbearing age in sub-Saharan Africa. There is sparse data about socio-economic factors in the context with adverse outcome in pregnancy. The objective of the study was to identify such factors for prematurity, low birth weight (LBW) and intrauterine growth retardation (IUGR) in infants born to HIV-positive women in Cameroon. Methods: The study was done in Yaoundé between December 2001 and November 2007. Neonates born to HIV-positive mothers were monitored and clinical data as well as socio-economic factors were tested for association with prematurity, LBW and IUGR. Findings: In total, 264 neonates were analyzed. More prematurity occurred when mothers attended less than 4 prenatal care visits (OR [95% CI]: 2.7 [1.21-6.05]; p=0.015). HIV-classification >1 resulted in more IUGR (OR [95% CI]): 3.15 [1.4-7.4]; p=0.01) and LBW (2.20 [1.1-4.6]; p=0.03). Single women were more likely to attend 4 prenatal care visits or more (OR [CI95%]: 2.4 [1.6-3.4]; p<0.001); higher education resulted in better compliance with anaemia prophylaxis (OR [CI95%]: 3.0 [1.5-5.8]; p=0.002) and antimalaria prophylaxis (OR [CI95%]: 2.1 [1.4-3.3]; p<0.001); and was associated with early HIV diagnosis (p=0.003). Conclusion: Prenatal care improves outcome in pregnancy of HIV-positive women. Single mothers compared to women in family settings are more likely to attend prenatal care visits, and HIV was diagnosed earlier in pregnancy in this population. More effort should be put to address women in family settings to early diagnose HIV and to increase compliance with prenatal care.
Highlights
Low birth weight (LBW), prematurity and intrauterine growth (IUGR) is associated with considerable morbidity and mortality in the neonatal period as well as in the first year and adult life [1,2,3,4,5]
Single women were more likely to attend 4 prenatal care visits or more (OR [CI95%]: 2.4 [1.6 - 3.4]; p < 0.001); higher education resulted in better compliance with anaemia prophylaxis (OR [CI95%]: 3.0 [1.5 - 5.8]; p = 0.002) and antimalaria prophylaxis (OR [CI95%]: 2.1 [1.4 - 3.3]; p < 0.001); and was associated with early Human immunodeficiency virus (HIV) diagnosis (p = 0.003)
Enrolment: Among a total of 15379 children born at University of Yaoundé Teaching Hospital (UYT) during the study period, 496 children were born to HIV-1-positive mothers (Figure 1): 119 neonates were excluded because their mothers did not have prenatal care at UYT and information about pregnancy was not obtainable; 113 neonates were excluded from final analysis because documents were less than 75% complete
Summary
Low birth weight (LBW), prematurity and intrauterine growth (IUGR) is associated with considerable morbidity and mortality in the neonatal period as well as in the first year and adult life [1,2,3,4,5]. LBW often is due to IUGR, prematurity or a combination of both Other factors such as a lower socio economic status, a singleparent family, extreme maternal age at delivery ( < 20 or > 34 years), a lower education level, short intervals between pregnancies, multiple pregnancy, tobacco and/or alcohol use during pregnancy, low weight gain during pregnancy, and chronic illness of the mother have been associated with LBW as well [6,7,8,9,10]. There is a direct correlation between vertical HIV transmission, LBW and a high mortality [16,17,18,19]
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