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

Sera Young, Katherine Murray, Julia Mwesigwa, Paul Natureeba, Beth Osterbauer, Jane Achan, Emmanuel Arinaitwe, Tamara Clark, Veronica Ades, Albert Plenty, Edwin Charlebois, Theodore Ruel, Moses Kamya, Diane Havlir, Deborah Cohan, Sera Young, Katherine Murray, Julia Mwesigwa, Paul Natureeba, Beth Osterbauer, Jane Achan, Emmanuel Arinaitwe, Tamara Clark, Veronica Ades, Albert Plenty, Edwin Charlebois, Theodore Ruel, Moses Kamya, Diane Havlir, Deborah Cohan

Abstract

Objective: 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.

Design: Prospective cohort.

Methods: 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.

Results: 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%.

Conclusions: 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.

Trial registration: Clinicaltrials.gov NCT00993031.

Conflict of interest statement

Competing Interests: The authors have the following interests to declare: Abbott Laboratories provides Lopinavir/ritonavir for the parent trial. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials, as detailed online in the guide for authors.

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