As the availability of combination antiretroviral therapy (cART) for HIV-infected pregnant women broadens and perinatal HIV transmission is reduced, there are increasing numbers of HIV-exposed, uninfected children worldwide . Studies to date suggest that these children have worse outcomes compared to their HIV-unexposed counterparts –. Preterm delivery (PTD), low birth weight (LBW), stunting, and other markers of fetal growth restriction are important predictors of neonatal mortality, post-neonatal infant mortality, and infant and child morbidity –. Among the many factors that predict poor gestational outcomes, maternal nutritional status before and during pregnancy has emerged as a major modifiable determinant , –.
Specifically, pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) have repeatedly been associated with LBW –. Little is known, however, about the relationship between maternal nutritional status and birth outcomes among HIV-infected women on cART, particularly in the resource-constrained settings of rural sub-Saharan Africa.
Given that nutritional status is a strong modifiable predictor of birth outcomes, we sought to characterize the baseline nutritional status of pregnant women initiating cART in rural Uganda and examine the associations between their nutritional status and adverse birth outcomes.
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.
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.