title: Maternal weight loss during exclusive breastfeeding is associated with reduced weight and length gain in daughters of HIV-infected Malawian women.
abstract: Maternal weight loss during exclusive breastfeeding may influence the growth of exclusively breast-fed infants through impaired quality or quantity of breast milk. This study evaluated how maternal weight loss from 2 to 24 wk postpartum was related to infant weight and length gain in 1309 lactating HIV-infected mothers and their exclusively breast-fed infants. Malawian mother-infant pairs in the Breastfeeding, Antiretrovirals, and Nutrition Study were randomized with a 2 × 3 factorial design to a 2-arm nutritional intervention with a lipid-based nutrient supplement (LNS), meeting nutritional needs of lactation, or no LNS and a 3-arm antiretroviral (ARV) intervention (maternal, infant, or no ARV regimen). Linear regression models were used to relate maternal weight loss (weight loss vs. no weight loss) to infant weight and length gain from birth to 24 mo, stratifying by gender and controlling for maternal BMI at 2 wk (mean ± SD: 23.2 ± 3.0 kg/m(2)) and interacting maternal BMI with weight loss. In adjusted models, compared with daughters of women who did not lose weight, length and weight gain were lower in daughters whose mothers had a lower BMI at 2 wk postpartum coupled with the weight loss. For example, among mothers with an initial BMI of 18 kg/m(2), daughters of those who lost weight gained less weight [β = -0.29 kg (95% CI: -0.53, -0.06)] and length [β = -0.88 cm (95% CI: -1.52, -0.23)] from birth to 24 wk than daughters of those who gained weight. Though effects were only observed in girls, suggesting possible gender differences in suckling and feeding behavior, these findings indicate that maternal weight loss with low energy reserves represents a risk factor for poor infant growth outcomes.
authors.affiliation: Institute of Human Nutrition and Department of Epidemiology, Columbia University, New York, NY, USA. ew2435@columbia.edu
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Widen
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Bentley
authors.forename: Dumbani
authors.initials: D
authors.lastname: Kayira
authors.forename: Charles S
authors.initials: CS
authors.lastname: Chasela
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.forename: Martin
authors.initials: M
authors.lastname: Tembo
authors.forename: Alice
authors.initials: A
authors.lastname: Soko
authors.forename: Athena P
authors.initials: AP
authors.lastname: Kourtis
authors.forename: Valerie L
authors.initials: VL
authors.lastname: Flax
authors.forename: Sascha R
authors.initials: SR
authors.lastname: Ellington
authors.forename: Charles M
authors.initials: CM
authors.lastname: van der Horst
authors.forename: Linda S
authors.initials: LS
authors.lastname: Adair
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001827:Body Height; D001942:Breast Feeding; D002657:Child Development / Q000502:physiology*; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D005260:Female; D015658:HIV Infections / Q000178:diet therapy / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007774:Lactation; D016014:Linear Models; D016015:Logistic Models; D008295:Malawi / Q000453:epidemiology; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D008895:Milk, Human; D011247:Pregnancy; D015430:Weight Gain; D015431:Weight Loss; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents