Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
College of Medicine, University of Malawi, Blantyre, Malawi.
BMC Pregnancy Childbirth. 2021 Sep 23;21(1):646. doi: 10.1186/s12884-021-04118-4.
High rates of adverse pregnancy outcomes globally raise the need to understand risk factors and develop preventative interventions. The Pregnancy Outcomes in the Era of Universal Antiretroviral Treatment in Sub-Saharan Africa (POISE Study) was a prospective, observational cohort study conducted from 2016 to 2017 in Blantyre, Malawi. We examine the associations between indicators of nutritional status, specifically mid-thigh circumference (MTC) and body-mass index (BMI), and adverse pregnancy outcomes, low birth weight (LBW), preterm birth (PTB), and small-for-gestational age (SGA), in a cohort of HIV-infected and HIV-uninfected women.
Sociodemographic, clinical, laboratory, and maternal height, weight and MTC data were collected immediately before or after delivery at the Queen Elizabeth Central Hospital (QEHC) and 4 affiliated health centers in Blantyre, Malawi. LBW was defined as birth weight < 2.5 kg; PTB as gestational age < 37 weeks using Ballard score; and SGA as birth weight < 10th percentile for gestational age. Descriptive, stratified, and multivariable logistic regression were conducted using R.
Data from 1298 women were analyzed: 614 HIV-infected and 684 HIV-uninfected. MTC was inversely associated with LBW (adjusted odds ratio [aOR] = 0.95, p = 0.03) and PTB (aOR 0.92, p < 0.001), after controlling for HIV status, age, socioeconomic status and hemoglobin. The association between MTC and SGA was (aOR 0.99, p = 0.53). Similarly, higher BMI was significantly associated with lower odds of PTB (aOR 0.90, p < 0.001), LBW (aOR 0.93, p = 0.05), and SGA (aOR 0.95, p = 0.04).
We observed an inverse relationship between MTC and adverse pregnancy outcomes in Malawi irrespective of HIV infection. MTC performs comparably to BMI; the ease of measuring MTC could make it a practical tool in resource-constrained settings for identification of women at risk of adverse pregnancy outcomes.
全球范围内不良妊娠结局发生率较高，这就需要我们了解风险因素并制定预防干预措施。在撒哈拉以南非洲，抗逆转录病毒治疗时代的妊娠结局（POISE 研究）是一项前瞻性观察队列研究，于 2016 年至 2017 年在马拉维布兰太尔的伊丽莎白女王中央医院（QEHC）及其附属的 4 个医疗中心进行。我们研究了营养状况指标（大腿中部周长（MTC）和体重指数（BMI））与 HIV 感染和未感染妇女不良妊娠结局（低出生体重（LBW）、早产（PTB）和小于胎龄儿（SGA））之间的关联。
在马拉维布兰太尔的伊丽莎白女王中央医院（QEHC）及其附属的 4 个医疗中心，在分娩前后立即收集社会人口统计学、临床、实验室以及孕产妇身高、体重和 MTC 数据。LBW 定义为出生体重 <2.5 公斤；PTB 定义为使用 Ballard 评分的妊娠龄 <37 周；SGA 定义为出生体重 <胎龄第 10 个百分位数。使用 R 进行描述性、分层和多变量逻辑回归分析。
对 1298 名妇女的数据进行了分析：614 名 HIV 感染和 684 名 HIV 未感染。在校正 HIV 状态、年龄、社会经济地位和血红蛋白后，MTC 与 LBW（调整后优势比[aOR] = 0.95，p = 0.03）和 PTB（aOR 0.92，p < 0.001）呈负相关。MTC 与 SGA 之间的关联为（aOR 0.99，p = 0.53）。同样，较高的 BMI 与较低的 PTB（aOR 0.90，p < 0.001）、LBW（aOR 0.93，p = 0.05）和 SGA（aOR 0.95，p = 0.04）发生的几率相关。
在马拉维，我们观察到 MTC 与不良妊娠结局之间存在反比关系，无论是否存在 HIV 感染。MTC 与 BMI 表现相当；与 BMI 相比，MTC 更容易测量，因此在资源有限的情况下，它可能成为一种识别不良妊娠结局风险妇女的实用工具。
