赞比亚感染 HIV 的女性产后哺乳期体重变化。
Lactation-associated postpartum weight changes among HIV-infected women in Zambia.
机构信息
Center for AIDS Prevention Studies, University of California San Francisco, CA, USA.
出版信息
Int J Epidemiol. 2010 Oct;39(5):1299-310. doi: 10.1093/ije/dyq065. Epub 2010 May 19.
BACKGROUND
There are concerns about effects of lactation on postpartum weight changes among HIV-infected women because low weight may increase risks of HIV-related disease progression.
METHODS
This analysis of postpartum maternal weight change is based on a trial evaluating the effects of shortened breastfeeding on postpartum mother-to-child transmission of HIV in Lusaka, Zambia, in which 958 HIV-infected women were randomized to breastfeed for a short duration (4 months) or for a duration of their own informed choosing (median 16 months). Among 768 women who met inclusion criteria, we compared across the two groups change in weight (kg) and the percent underweight [body mass index (BMI) <18.5] through 24 months. We also examined the effect of breastfeeding in two high-risk groups: those with low BMI and those with low CD4 counts.
RESULTS
Overall, women in the long-duration group gained less weight compared with those in the short-duration group from 4-24 months {1.0 kg [95% confidence interval (CI): 0.3-1.7] vs 2.3 kg (95% CI: 1.6-2.9), P = 0.01}. No association was found between longer breastfeeding and being underweight (odds ratio 1.1; 95% CI: 0.8-1.6; P = 0.40). Effects of lactation in underweight women and women with low CD4 counts were similar to the effects in women with higher BMI and higher CD4 counts. Women with low baseline BMI tended to gain more weight from 4 to 24 months than those with higher BMI, regardless of breastfeeding duration (2.1 kg, 95% CI: 1.3-2.9; P < 0.01).
CONCLUSIONS
In this study of HIV-infected breastfeeding women in a low-resource setting, the average change in weight from 4 to 24 months postpartum was a net gain rather than loss. Although longer duration breastfeeding was associated with less weight gain, breastfeeding duration was not associated with being underweight (BMI < 18.5). Weight change associated with longer breastfeeding may be metabolically regulated so that women with low BMI and at risk of wasting are protected from excess weight loss.
背景
人们对哺乳期对 HIV 感染者产后体重变化的影响感到担忧，因为体重过低可能会增加与 HIV 相关疾病进展的风险。
方法
这项产后母体体重变化的分析基于一项评估缩短母乳喂养对赞比亚卢萨卡母婴 HIV 传播影响的试验，其中 958 名 HIV 感染妇女被随机分为短时间（4 个月）或自行选择的母乳喂养时间（中位数 16 个月）。在符合纳入标准的 768 名妇女中，我们比较了两组在 24 个月内体重（kg）的变化和体重不足的比例[体重指数（BMI）<18.5]。我们还检查了母乳喂养在两个高危人群中的效果：BMI 较低和 CD4 计数较低的人群。
结果
总体而言，与短时间组相比，长时间组的妇女从 4 至 24 个月体重增加较少{1.0kg（95%置信区间：0.3-1.7）比 2.3kg（95%置信区间：1.6-2.9），P=0.01}。母乳喂养时间较长与体重不足（比值比 1.1；95%置信区间：0.8-1.6；P=0.40）之间没有关联。哺乳期对体重不足的妇女和 CD4 计数较低的妇女的影响与 BMI 和 CD4 计数较高的妇女的影响相似。无论母乳喂养时间长短，低基线 BMI 的妇女在从 4 至 24 个月期间体重增加的幅度都大于 BMI 较高的妇女（2.1kg，95%置信区间：1.3-2.9；P<0.01）。
结论
在这项资源匮乏环境下对 HIV 感染母乳喂养妇女的研究中，从 4 至 24 个月产后体重的平均变化是净增而不是减少。尽管母乳喂养时间较长与体重增加较少有关，但母乳喂养时间与体重不足（BMI<18.5）无关。与延长母乳喂养相关的体重变化可能受到代谢调节，因此 BMI 较低且有消瘦风险的妇女不会出现体重过度下降。
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