title: Maternal nutritional status predicts adverse birth outcomes among HIV-infected rural Ugandan women receiving combination antiretroviral therapy.
abstract: OBJECTIVE
  Maternal nutritional status is an important predictor of birth outcomes, yet little is known about the nutritional status of HIV-infected pregnant women treated with combination antiretroviral therapy (cART). We therefore examined the relationship between maternal BMI at study enrollment, gestational weight gain (GWG), and hemoglobin concentration (Hb) among 166 women initiating cART in rural Uganda.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  HIV-infected, ART-naïve pregnant women were enrolled between 12 and 28 weeks gestation and treated with a protease inhibitor or non-nucleoside reverse transcriptase inhibitor-based combination regimen. Nutritional status was assessed monthly. Neonatal anthropometry was examined at birth. Outcomes were evaluated using multivariate analysis.
  
  
  RESULTS
  Mean GWG was 0.17 kg/week, 14.6% of women experienced weight loss during pregnancy, and 44.9% were anemic. Adverse fetal outcomes included low birth weight (LBW) (19.6%), preterm delivery (17.7%), fetal death (3.9%), stunting (21.1%), small-for-gestational age (15.1%), and head-sparing growth restriction (26%). No infants were HIV-infected. Gaining <0.1 kg/week was associated with LBW, preterm delivery, and a composite adverse obstetric/fetal outcome. Maternal weight at 7 months gestation predicted LBW. For each g/dL higher mean Hb, the odds of small-for-gestational age decreased by 52%.
  
  
  CONCLUSIONS
  In our cohort of HIV-infected women initiating cART during pregnancy, grossly inadequate GWG was common. Infants whose mothers gained <0.1 kg/week were at increased risk for LBW, preterm delivery, and composite adverse birth outcomes. cART by itself may not be sufficient for decreasing the burden of adverse birth outcomes among HIV-infected women.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00993031.
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America.
authors.forename: Sera
authors.initials: S
authors.lastname: Young
authors.forename: Katherine
authors.initials: K
authors.lastname: Murray
authors.forename: Julia
authors.initials: J
authors.lastname: Mwesigwa
authors.forename: Paul
authors.initials: P
authors.lastname: Natureeba
authors.forename: Beth
authors.initials: B
authors.lastname: Osterbauer
authors.forename: Jane
authors.initials: J
authors.lastname: Achan
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Arinaitwe
authors.forename: Tamara
authors.initials: T
authors.lastname: Clark
authors.forename: Veronica
authors.initials: V
authors.lastname: Ades
authors.forename: Albert
authors.initials: A
authors.lastname: Plenty
authors.forename: Edwin
authors.initials: E
authors.lastname: Charlebois
authors.forename: Theodore
authors.initials: T
authors.lastname: Ruel
authors.forename: Moses
authors.initials: M
authors.lastname: Kamya
authors.forename: Diane
authors.initials: D
authors.lastname: Havlir
authors.forename: Deborah
authors.initials: D
authors.lastname: Cohan
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D005317:Fetal Growth Retardation / Q000473:pathology; D005333:Fetus / Q000187:drug effects; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D039382:Maternal Nutritional Physiological Phenomena / Q000187:drug effects; D015999:Multivariate Analysis; D009752:Nutritional Status / Q000187:drug effects; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D012424:Rural Population; D014454:Uganda; D015430:Weight Gain / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents