Low birth weight in perinatally HIV-exposed uninfected infants: observations in urban settings in Cameroon

Casimir Ledoux Sofeu, Josiane Warszawski, Francis Ateba Ndongo, Ida Calixte Penda, Suzie Tetang Ndiang, Georgette Guemkam, Nicaise Makwet, Félicité Owona, Anfumbom Kfutwah, Patrice Tchendjou, Gaëtan Texier, Maurice Tchuente, Albert Faye, Mathurin Cyrille Tejiokem, ANRS-PEDIACAM Study Group, Albert Faye, Mathurin Cyrille Tejiokem, Françoise Barré-Sinoussi, Daniel Scott, Frédéric Tangy, Josiane Warszawski, Stéphane Blanche, Catherine Dollfus, Laurence Baril, Anfumbom Kfutwah, Ida Penda, Georgette Guemkam, Ateba Ndongo Francis, Chantal Biya, Suzie Tetang Ndiang, Epouner Denise, Mbanzouen William, Ngoupo Paul Alain, Owona Félicité, Sofeu Casimir Ledoux, Texier Gaëtan, Tchendjou Patrice, Bossolo Juste, Ehongo Jean Marie, Evouna Armel, Mbida Patricia, Ndongo Jean Audrey, Nguefack Félicité, Mbu Robinson, Koki Paul, Bekono Ernestine, Belinga Marie Louise, Evoundou Dieudonné, Nga Annie, Nguen Suzanne, Njom Nlend Anne, Onono Yvette, Wamba Guillaume, Zeudja, Alibien Michelle, Dissongo Jean 2nd, Djene Julie, Ewané Valery, Makwet Nicaise, Mbangué Madeleine, Ngo Sohna Aurore, Ngwa, Obedat Shiro, Casimir Ledoux Sofeu, Josiane Warszawski, Francis Ateba Ndongo, Ida Calixte Penda, Suzie Tetang Ndiang, Georgette Guemkam, Nicaise Makwet, Félicité Owona, Anfumbom Kfutwah, Patrice Tchendjou, Gaëtan Texier, Maurice Tchuente, Albert Faye, Mathurin Cyrille Tejiokem, ANRS-PEDIACAM Study Group, Albert Faye, Mathurin Cyrille Tejiokem, Françoise Barré-Sinoussi, Daniel Scott, Frédéric Tangy, Josiane Warszawski, Stéphane Blanche, Catherine Dollfus, Laurence Baril, Anfumbom Kfutwah, Ida Penda, Georgette Guemkam, Ateba Ndongo Francis, Chantal Biya, Suzie Tetang Ndiang, Epouner Denise, Mbanzouen William, Ngoupo Paul Alain, Owona Félicité, Sofeu Casimir Ledoux, Texier Gaëtan, Tchendjou Patrice, Bossolo Juste, Ehongo Jean Marie, Evouna Armel, Mbida Patricia, Ndongo Jean Audrey, Nguefack Félicité, Mbu Robinson, Koki Paul, Bekono Ernestine, Belinga Marie Louise, Evoundou Dieudonné, Nga Annie, Nguen Suzanne, Njom Nlend Anne, Onono Yvette, Wamba Guillaume, Zeudja, Alibien Michelle, Dissongo Jean 2nd, Djene Julie, Ewané Valery, Makwet Nicaise, Mbangué Madeleine, Ngo Sohna Aurore, Ngwa, Obedat Shiro

Abstract

Background: The consequences of maternal HIV infection for fetal growth are controversial. Here, we estimated the frequency of small for gestational age and gender (SGAG) among neonates born to HIV-infected or uninfected mothers and assessed the contribution, if any, of maternal HIV to the risk of SGAG.

Methods: The data used were obtained from the ANRS-Pediacam cohort in Cameroon. Pairs of newborns, one to a HIV-infected mother and the other to an uninfected mother, were identified during the first week of life, and matched on gender and recruitment site from 2007-2010. SGAG was defined in line with international recommendations as a birth weight Z-score adjusted for gestational age at delivery and gender more than two standard deviations below the mean (-2SD). Considering the matched design, logistic regression modeling was adjusted on site and gender to explore the effect of perinatal HIV exposure on SGAG.

Results: Among the 4104 mother-infant pairs originally enrolled, no data on birth weight and/or gestational age were available for 108; also, 259 were twins and were excluded. Of the remaining 3737 mother-infant pairs, the frequency of SGAG was 5.3% (95%CI: 4.6-6.0), and was significantly higher among HIV-infected infants (22.4% vs. 6.3%; p<.001) and lower among HIV-unexposed uninfected infants (3.5% vs. 6.3%; p<.001) than among HIV-exposed uninfected infants. Similarly, SGAG was significantly more frequent among HIV-infected infants (aOR: 4.1; 2.0-8.1) and less frequent among HIV-unexposed uninfected infants (aOR: 0.5; 0.4-0.8) than among HIV-exposed uninfected infants. Primiparity (aOR: 1.9; 1.3-2.7) and the presence of any disease during pregnancy (aOR: 1.4; 1.0-2.0) were identified as other contributors to SGAG.

Conclusion: Maternal HIV infection was independently associated with SGAG for HIV-exposed uninfected infants. This provides further evidence of the need for adapted monitoring of pregnancy in HIV-infected women, especially if they are symptomatic, to minimize additional risk factors for SGAG.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Study population and frequency of…
Figure 1. Study population and frequency of SGAG, ANRS 12140-Pediacam study, Cameroon, 2007–2010.
*Birth outcomes refer to birth weight and gestational age. † 9.3% (346) of infants were excluded from the multivariate analysis because of data for potentially associated factors were missing. ‡SGAG: small for gestational age and gender.

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