Maternal weight loss during exclusive breastfeeding is associated with reduced weight and length gain in daughters of HIV-infected Malawian women

Abstract

Maternal weight loss during exclusive breastfeeding may influence the growth of exclusively breast-fed infants through impaired quality or quantity of breast milk. This study evaluated how maternal weight loss from 2 to 24 wk postpartum was related to infant weight and length gain in 1309 lactating HIV-infected mothers and their exclusively breast-fed infants. Malawian mother-infant pairs in the Breastfeeding, Antiretrovirals, and Nutrition Study were randomized with a 2 × 3 factorial design to a 2-arm nutritional intervention with a lipid-based nutrient supplement (LNS), meeting nutritional needs of lactation, or no LNS and a 3-arm antiretroviral (ARV) intervention (maternal, infant, or no ARV regimen). Linear regression models were used to relate maternal weight loss (weight loss vs. no weight loss) to infant weight and length gain from birth to 24 mo, stratifying by gender and controlling for maternal BMI at 2 wk (mean ± SD: 23.2 ± 3.0 kg/m(2)) and interacting maternal BMI with weight loss. In adjusted models, compared with daughters of women who did not lose weight, length and weight gain were lower in daughters whose mothers had a lower BMI at 2 wk postpartum coupled with the weight loss. For example, among mothers with an initial BMI of 18 kg/m(2), daughters of those who lost weight gained less weight [β = -0.29 kg (95% CI: -0.53, -0.06)] and length [β = -0.88 cm (95% CI: -1.52, -0.23)] from birth to 24 wk than daughters of those who gained weight. Though effects were only observed in girls, suggesting possible gender differences in suckling and feeding behavior, these findings indicate that maternal weight loss with low energy reserves represents a risk factor for poor infant growth outcomes.

Trial registration: ClinicalTrials.gov NCT00164736.

Conflict of interest statement

Author disclosures: C. M. van der Horst received grant support from Abbott Laboratories and GlaxoSmithKline. E. M. Widen, M. E. Bentley, D. Kayira, C. S. Chasela, D. J. Jamieson, M. Tembo, A. Soko, A. P. Kourtis, V. L. Flax, S. R. Ellington, and L. S. Adair, no conflicts of interest.

Figures

FIGURE 1

Predicted infant weight (A) and length (B) at 24 wk for varying maternal BMI levels in BAN mother-infant pairs included in the primary analysis of the effects of maternal weight loss on infant growth. Predicted curves from linear regression models containing infant initial anthropometric measurement, maternal weight loss from 2 to 24 wk, maternal BMI at 2 wk postpartum, and an interaction term between maternal weight loss and BMI. Weight gain: boys, n = 673; girls, n = 633. Length gain: boys, n = 667; girls, n = 632. BAN, Breastfeeding, Antiretrovirals, and Nutrition.