Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Paediatr Perinat Epidemiol. 2020 Nov;34(6):713-723. doi: 10.1111/ppe.12688. Epub 2020 Jun 3.
South Africa faces dual epidemics of HIV and obesity; however, little research has explored whether HIV status influences associations between pre-pregnancy body mass index (BMI) and adverse birth outcomes.
To examine associations between pre-pregnancy body mass index (BMI) and adverse birth outcomes, and if they differ by HIV status.
We followed HIV-uninfected and -infected pregnant women initiating antiretroviral therapy (ART) from first antenatal visit through delivery. HIV-infected women initiated ART (tenofovir-emtricitabine/lamivudine-efavirenz) in pregnancy. Estimated pre-pregnancy BMI (kg/m ) was categorised as underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0). We used modified Poisson regression to estimate risk ratios (RR) for associations between pre-pregnancy BMI and adverse birth outcomes and explored modification by HIV status.
Among 1116 women (53% HIV-infected), 44% of HIV-uninfected women and 36% of HIV-infected women were classified as obese; 4% of women were underweight. Overall, 12% of infants were delivered preterm (<37 weeks), 10% small for gestational age (SGA, <10th percentile), and 9% large for gestational age (LGA, >90th percentile). Compared to HIV-uninfected women, HIV-infected women on ART had less LGA (5% vs 13%) but more SGA (12% vs 8%), and a similar proportion of preterm (13% vs 11%) infants. Pre-pregnancy BMI was not associated with preterm birth. Among HIV-uninfected women, obesity modestly increased the risk of LGA (RR 1.34, 95% confidence interval [CI] 0.82, 2.19), and underweight modestly elevated the risk of SGA (RR 1.66, 95% CI 0.79, 3.46). These associations were attenuated among HIV-infected women (RR 1.07, 95% CI 0.44, 2.64 for LGA, and RR 1.34, 95% CI 0.49, 3.64 for SGA).
In this urban African setting of high HIV prevalence, pre-pregnancy obesity was common and did not vary by HIV status. In HIV-uninfected women, obesity increased the risk of LGA and being underweight the risk of SGA, compared with among HIV-uninfected women.
南非面临着艾滋病毒和肥胖的双重流行，但很少有研究探讨艾滋病毒状况是否会影响孕前体重指数（BMI）与不良出生结局之间的关系。
研究孕前体重指数（BMI）与不良出生结局之间的关系，并探讨其是否因艾滋病毒状况而异。
我们随访了从首次产前检查到分娩期间开始接受抗逆转录病毒治疗（ART）的未感染和感染艾滋病毒的孕妇。感染艾滋病毒的孕妇在怀孕期间开始接受（替诺福韦-恩曲他滨/拉米夫定-依非韦伦）ART。估计的孕前 BMI（kg/m ）分为消瘦（<18.5）、正常（18.5-24.9）、超重（25.0-29.9）和肥胖（≥30.0）。我们使用修正泊松回归来估计孕前 BMI 与不良出生结局之间的风险比（RR），并探讨艾滋病毒状况的修饰作用。
在 1116 名妇女（53%感染艾滋病毒）中，44%的未感染艾滋病毒的妇女和 36%的感染艾滋病毒的妇女被归类为肥胖；4%的妇女消瘦。总体而言，12%的婴儿早产（<37 周），10%的婴儿小于胎龄（SGA，<第 10 百分位数），9%的婴儿大于胎龄（LGA，>第 90 百分位数）。与未感染艾滋病毒的妇女相比，接受 ART 的感染艾滋病毒的妇女 LGA 发生率较低（5%比 13%），SGA 发生率较高（12%比 8%），早产发生率相似（13%比 11%）。孕前 BMI 与早产无关。在未感染艾滋病毒的妇女中，肥胖适度增加了 LGA 的风险（RR 1.34，95%置信区间[CI] 0.82，2.19），消瘦适度增加了 SGA 的风险（RR 1.66，95%CI 0.79，3.46）。这些关联在感染艾滋病毒的妇女中减弱（RR 1.07，95%CI 0.44，2.64 为 LGA，RR 1.34，95%CI 0.49，3.64 为 SGA）。
在这个艾滋病毒流行率较高的非洲城市环境中，孕前肥胖很常见，且与艾滋病毒状况无关。在未感染艾滋病毒的妇女中，与未感染艾滋病毒的妇女相比，肥胖会增加 LGA 的风险，而消瘦会增加 SGA 的风险。
