Centre for Child Health Research, Faculty of Medicine and Health Technology, Tampere, University, Tampere, Finland.
Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
PLoS One. 2019 May 2;14(5):e0215760. doi: 10.1371/journal.pone.0215760. eCollection 2019.
Both maternal HIV infection and antiretroviral therapy are associated with adverse birth outcomes. The role of antenatal nutrient supplements with regard to adverse birth outcomes in HIV infected women exposed to antiretroviral therapy is not well known. We assessed the association between HIV and birth outcomes and explored whether antenatal lipid-based nutrient supplements (LNS) modulated this association.
We analysed a nested cohort of pregnant Malawian women who received daily LNS, multiple micronutrients (MMN) or iron and folic acid (IFA). Birth weight, length-for-age z-score (LAZ) and weight-for-age z-score (WAZ) were analysed as continuous outcomes and proportion of stunting and small-for-gestational age (SGA) as dichotomous outcomes.
134 HIV infected (46 LNS, 39 MMN, 49 IFA) and 833 HIV uninfected (271 LNS, 287 MMN, 275 IFA) women were included. Maternal HIV infection was associated with a lower mean birth weight (-129g (-209, -48), P = 0.002); LAZ (-0.34 (-0.54, -0.13), P = 0.002) and WAZ (-0.21 (-0.40, -0.02), P = 0.041) and a higher risk of stunting (RR (95% confidence interval), 1.87 (1.24, 2.83), P = 0.003) and SGA (1.66 (1.21, 2.26), P = 0.001) in the newborn. If the women received LNS, HIV was not associated with LAZ (mean difference (95%); -0.02 (-0.35, 0.31), P = 0.918) or newborn stunting (RR (95% CI), 0.84 (0.34, 2.03), P = 0.691). However HIV tended to be associated with LAZ if the women received MMN (-0.42 (-0.80, -0.03), P = 0.053); and was significantly associated with LAZ if the women received IFA (-0.52 (-0.89, -0.14), P = 0.021) and with newborn stunting if they received MMN (2.40 (1.15, 4.98), P = 0.029) or IFA (2.40 (1.26, 4.59), P = 0.024).
Further research to investigate the impact of LNS on various aspects of foetal growth in HIV infected women is warranted.
母体 HIV 感染和抗逆转录病毒治疗均与不良出生结局相关。在接受抗逆转录病毒治疗的 HIV 感染妇女中，产前营养补充剂对不良出生结局的作用尚不清楚。我们评估了 HIV 与出生结局之间的关系，并探讨了产前基于脂质的营养补充剂（LNS）是否调节了这种关联。
我们分析了一个嵌套队列，其中包括接受每日 LNS、多种微量营养素（MMN）或铁和叶酸（IFA）的马拉维孕妇。体重、年龄别身长 z 评分（LAZ）和年龄别体重 z 评分（WAZ）作为连续结果进行分析，生长迟缓（体重小于胎龄儿，SGA）和比例为二项结果。
共纳入 134 名 HIV 感染（46 名 LNS、39 名 MMN、49 名 IFA）和 833 名 HIV 未感染（271 名 LNS、287 名 MMN、275 名 IFA）的妇女。母亲 HIV 感染与平均出生体重降低（-129g（-209，-48），P=0.002）、LAZ（-0.34（-0.54，-0.13），P=0.002）和 WAZ（-0.21（-0.40，-0.02），P=0.041）降低以及新生儿生长迟缓（RR（95%置信区间），1.87（1.24，2.83），P=0.003）和 SGA（1.66（1.21，2.26），P=0.001）的风险增加有关。如果妇女接受 LNS，则 HIV 与 LAZ （平均差异（95%），-0.02（-0.35，0.31），P=0.918）或新生儿生长迟缓（RR（95%CI），0.84（0.34，2.03），P=0.691）无关。然而，如果妇女接受 MMN，则 HIV 与 LAZ 呈正相关（-0.42（-0.80，-0.03），P=0.053）；如果妇女接受 IFA，则 HIV 与 LAZ 显著相关（-0.52（-0.89，-0.14），P=0.021）；如果妇女接受 MMN（2.40（1.15，4.98），P=0.029）或 IFA（2.40（1.26，4.59），P=0.024），则 HIV 与新生儿生长迟缓呈正相关。
需要进一步研究以调查 LNS 对 HIV 感染妇女胎儿生长各个方面的影响。
