Maternal nutritional status predicts adverse birth outcomes among HIV-infected Rural Ugandan women receiving combination antiretroviral therapy.

Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America.
PLoS ONE (Impact Factor: 3.53). 08/2012; 7(8):e41934. DOI: 10.1371/journal.pone.0041934
Source: PubMed

ABSTRACT Maternal nutritional status is an important predictor of birth outcomes, yet little is known about the nutritional status of HIV-infected pregnant women treated with combination antiretroviral therapy (cART). We therefore examined the relationship between maternal BMI at study enrollment, gestational weight gain (GWG), and hemoglobin concentration (Hb) among 166 women initiating cART in rural Uganda.
Prospective cohort.
HIV-infected, ART-naïve pregnant women were enrolled between 12 and 28 weeks gestation and treated with a protease inhibitor or non-nucleoside reverse transcriptase inhibitor-based combination regimen. Nutritional status was assessed monthly. Neonatal anthropometry was examined at birth. Outcomes were evaluated using multivariate analysis.
Mean GWG was 0.17 kg/week, 14.6% of women experienced weight loss during pregnancy, and 44.9% were anemic. Adverse fetal outcomes included low birth weight (LBW) (19.6%), preterm delivery (17.7%), fetal death (3.9%), stunting (21.1%), small-for-gestational age (15.1%), and head-sparing growth restriction (26%). No infants were HIV-infected. Gaining <0.1 kg/week was associated with LBW, preterm delivery, and a composite adverse obstetric/fetal outcome. Maternal weight at 7 months gestation predicted LBW. For each g/dL higher mean Hb, the odds of small-for-gestational age decreased by 52%.
In our cohort of HIV-infected women initiating cART during pregnancy, grossly inadequate GWG was common. Infants whose mothers gained <0.1 kg/week were at increased risk for LBW, preterm delivery, and composite adverse birth outcomes. cART by itself may not be sufficient for decreasing the burden of adverse birth outcomes among HIV-infected women. NCT00993031.

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    ABSTRACT: Objective:To evaluate the safety of combination antiretroviral therapy (ART) in conception and pregnancy in different health systems.Design:A pilot ART registry to measure the prevalence of birth defects and adverse pregnancy outcomes in South Africa and Zambia.Methods:HIV-infected pregnant women on ART prior to conception were enrolled until delivery, and their infants were followed until 1 year old.Results:Between October 2010 and April 2011, 600 women were enrolled. The median CD4(+) cell count at study enrollment was lower in South Africa than Zambia (320 vs. 430cells/l; P<0.01). The most common antiretroviral drugs at the time of conception included stavudine, lamivudine, and nevirapine. There were 16 abortions (2.7%), one ectopic pregnancy (0.2%), 12 (2.0%) stillbirths, and 571 (95.2%) live infants. Deliveries were more often preterm (29.7 vs. 18.4%; P=0.01) and the infants had lower birth weights (2900 vs. 2995g; P=0.11) in Zambia compared to South Africa. Thirty-six infants had birth defects: 13 major and 23 minor. There were more major anomalies detected in South Africa and more minor ones in Zambia. No neonatal deaths were attributed to congenital birth defects.Conclusions:An Africa-specific, multi-site antiretroviral drug safety registry for pregnant women is feasible. Different prevalence for preterm delivery, delivery mode, and birth defect types between women on preconception ART in South Africa and Zambia highlight the potential impact of health systems on pregnancy outcomes. As countries establish ART drug safety registries, documenting health facility limitations may be as essential as the specific ART details.
    AIDS (London, England) 08/2014; 28(15). DOI:10.1097/QAD.0000000000000394 · 6.56 Impact Factor
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    ABSTRACT: Objective To examine maternal characteristics associated with adverse pregnancy outcomes among women infected with HIV. DesignProspective cohort study. SettingMultiple sites in Latin America and the Caribbean. PopulationWomen infected with HIV enrolled in the Perinatal (2002–2007) and the Longitudinal Study in Latin American Countries (LILAC; 2008–2012) studies of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) International Site Development Initiative (NISDI). Methods Frequencies of adverse pregnancy outcomes assessed among pregnancies. Risk factors investigated by logistic regression analysis. Main outcome measuresAdverse pregnancy outcomes, including preterm delivery (PT), low birthweight (LBW), small for gestational age (SGA), stillbirth (SB), and neonatal death. ResultsAmong 1512 women, 1.9% (95% confidence interval, 95% CI, 1.3–2.7) of singleton pregnancies resulted in a stillbirth and 32.9% (95% CI 30.6–35.4) had at least one adverse pregnancy outcome. Of 1483 singleton live births, 19.8% (95% CI 17.8–21.9) were PT, 14.2% (95% CI 12.5–16.1) were LBW, 12.6% (95% CI 10.9–14.4) were SGA, and 0.4% (95% CI 0.2–0.9) of infants died within 28 days of birth. Multivariable logistic regression modelling indicated that the following risk factors increased the probability of having one or more adverse pregnancy outcomes: lower maternal body mass index at delivery (odds ratio, OR, 2.2; 95% CI 1.4–3.5), hospitalisation during pregnancy (OR 3.3; 95% CI 2.0–5.3), hypertension during pregnancy (OR 2.7; 95% CI 1.5–4.8), antiretroviral use at conception (OR 1.4; 95% CI 1.0–1.9), and tobacco use during pregnancy (OR 1.7; 95% CI 1.3–2.2). The results of fitting multivariable logistic regression models for PT, LBW, SGA, and SB are also reported. Conclusions Women infected with HIV had a relatively high occurrence of adverse pregnancy outcomes, and some maternal risk factors were associated with these adverse pregnancy outcomes. Interventions targeting modifiable risk factors should be evaluated further.
    BJOG An International Journal of Obstetrics & Gynaecology 03/2014; 121(12). DOI:10.1111/1471-0528.12680 · 3.86 Impact Factor

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