SA MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Private Bag X3, Johannesburg, 2050, South Africa.
DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
BMC Pregnancy Childbirth. 2023 Jun 3;23(1):415. doi: 10.1186/s12884-023-05743-x.
In utero exposure to human immunodeficiency virus (HIV) and antiretroviral (ART) is associated with adverse birth outcomes, which are often attributed to alterations in placental morphology. This study used structural equation models (SEMs) to examine the impact of HIV and ART exposure on fetal growth outcomes and whether these associations are mediated by placental morphology in urban-dwelling Black South African women.
This prospective cohort study included pregnant women living with HIV (WLWH, n = 122) and not living with HIV (WNLWH, n = 250) that underwent repeated ultrasonography during pregnancy, and at delivery, to determine fetal growth parameters in Soweto, South Africa. The size and the velocity of fetal growth measures (i.e., head and abdominal circumference, biparietal diameter, and femur length) were calculated using the Superimposition by Translation and Rotation. Placenta digital photographs taken at delivery were used to estimate morphometric parameters and trimmed placental weight was measured. All WLWH were receiving ART for the prevention of vertical transmission of HIV.
A trend towards a lower placental weight and significantly shorter umbilical cord length was reported in WLWH compared to their counterparts. After sex stratification, umbilical cord length was significantly shorter in males born to WLWH than in male fetuses born to WNLWH (27.3 (21.6-32.8) vs. 31.4 (25.0-37.0) cm, p = 0.015). In contrast, female fetuses born to WLWH had lower placental weight, birth weight (2.9 (2.3-3.1) vs. 3.0 (2.7-3.2) kg), and head circumference (33 (32-34) vs. 34 (33-35) cm) than their counterparts (all p ≤ 0.05). The SEM models showed an inverse association between HIV and head circumference size and velocity in female fetuses. In contrast, HIV and ART exposure was positively associated with femur length growth (both size and velocity) and abdominal circumference velocity in male fetuses. None of these associations appeared to be mediated via placental morphology.
Our findings suggest that HIV and ART exposure directly affects head circumference growth in females and abdominal circumference velocity in male fetuses; but may improve femur length growth in male fetuses only.
子宫内暴露于人类免疫缺陷病毒（HIV）和抗逆转录病毒（ART）与不良出生结局相关，这些结局通常归因于胎盘形态的改变。本研究使用结构方程模型（SEM）来研究 HIV 和 ART 暴露对胎儿生长结局的影响，以及这些关联是否通过城市居住的南非黑人女性的胎盘形态来介导。
这项前瞻性队列研究纳入了 122 名患有 HIV 的孕妇（WLWH）和 250 名未患有 HIV 的孕妇（WNLWH），她们在南非索韦托进行了多次超声检查，以确定胎儿生长参数。使用平移和旋转叠加来计算胎儿生长指标（即头围和腹围、双顶径和股骨长）的大小和速度。在分娩时拍摄的胎盘数字照片用于估计形态参数，并测量修剪后的胎盘重量。所有 WLWH 均接受 ART 以预防 HIV 的垂直传播。
与对照组相比，WLWH 的胎盘重量呈下降趋势，脐带长度明显更短。在性别分层后，与男性胎儿出生于 WNLWH 的情况相比，出生于 WLWH 的男性胎儿的脐带长度明显更短（27.3（21.6-32.8）与 31.4（25.0-37.0）cm，p=0.015）。相比之下，出生于 WLWH 的女性胎儿的胎盘重量、出生体重（2.9（2.3-3.1）与 3.0（2.7-3.2）kg）和头围（33（32-34）与 34（33-35）cm）低于对照组（均 p≤0.05）。SEM 模型显示，HIV 与女性胎儿的头围大小和速度呈负相关。相反，HIV 和 ART 暴露与男性胎儿的股骨长度生长（大小和速度）和腹围速度呈正相关。这些关联似乎都没有通过胎盘形态来介导。
我们的研究结果表明，HIV 和 ART 暴露直接影响女性胎儿的头围生长和男性胎儿的腹围速度，但可能改善男性胎儿的股骨长度生长。
