Low birth weight in perinatally HIV-exposed uninfected infants: observations in urban settings in Cameroon.
BACKGROUND
The consequences of maternal HIV infection for fetal growth are controversial. Here, we estimated the frequency of small for gestational age and gender (SGAG) among neonates born to HIV-infected or uninfected mothers and assessed the contribution, if any, of maternal HIV to the risk of SGAG.


METHODS
The data used were obtained from the ANRS-Pediacam cohort in Cameroon. Pairs of newborns, one to a HIV-infected mother and the other to an uninfected mother, were identified during the first week of life, and matched on gender and recruitment site from 2007-2010. SGAG was defined in line with international recommendations as a birth weight Z-score adjusted for gestational age at delivery and gender more than two standard deviations below the mean (-2SD). Considering the matched design, logistic regression modeling was adjusted on site and gender to explore the effect of perinatal HIV exposure on SGAG.


RESULTS
Among the 4104 mother-infant pairs originally enrolled, no data on birth weight and/or gestational age were available for 108; also, 259 were twins and were excluded. Of the remaining 3737 mother-infant pairs, the frequency of SGAG was 5.3% (95%CI: 4.6-6.0), and was significantly higher among HIV-infected infants (22.4% vs. 6.3%; p<.001) and lower among HIV-unexposed uninfected infants (3.5% vs. 6.3%; p<.001) than among HIV-exposed uninfected infants. Similarly, SGAG was significantly more frequent among HIV-infected infants (aOR: 4.1; 2.0-8.1) and less frequent among HIV-unexposed uninfected infants (aOR: 0.5; 0.4-0.8) than among HIV-exposed uninfected infants. Primiparity (aOR: 1.9; 1.3-2.7) and the presence of any disease during pregnancy (aOR: 1.4; 1.0-2.0) were identified as other contributors to SGAG.


CONCLUSIONS
Maternal HIV infection was independently associated with SGAG for HIV-exposed uninfected infants. This provides further evidence of the need for adapted monitoring of pregnancy in HIV-infected women, especially if they are symptomatic, to minimize additional risk factors for SGAG.
Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun; Université de Yaoundé I, IRD UMI 209 UMMISCO, Yaoundé, Cameroun; Laboratoire International en Recherche Informatique et Mathématiques Appliquées, Equipe Idasco, Yaoundé, Cameroun.
Casimir Ledoux
CL
Sofeu
Equipe 4 (VIH et IST) - INSERM U1018 (CESP), Le Kremlin Bicêtre, France; Assistance Publique des Hôpitaux de Paris, Service d'Epidémiologie et de Santé Publique, Hôpital de Bicêtre, Le Kremlin Bicêtre, France; Université de Paris Sud 11, Paris, France.
Josiane
J
Warszawski
Centre Mère et Enfant de la Fondation Chantal Biya, Yaoundé, Cameroun.
Francis
F
Ateba Ndongo
Hôpital de Jour, Hôpital Laquintinie, Douala, Cameroun; Faculté de Médecine et des Sciences Pharmaceutiques, Université de Douala, Douala, Cameroun.
Ida Calixte
IC
Penda
Service de Pédiatrie, Centre Hospitalier d'Essos, Yaoundé, Cameroun.
Suzie
S
Tetang Ndiang
Centre Mère et Enfant de la Fondation Chantal Biya, Yaoundé, Cameroun; Maternité Principale, Hôpital Central, Yaoundé, Cameroun.
Georgette
G
Guemkam
Hôpital de Jour, Hôpital Laquintinie, Douala, Cameroun.
Nicaise
N
Makwet
Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun.
Félicité
F
Owona
Service de Virologie, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun.
Anfumbom
A
Kfutwah
Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun.
Patrice
P
Tchendjou
Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun; SESSTIM (UMR 912), Université Aix-Marseille, Marseille, France.
Gaëtan
G
Texier
Université de Yaoundé I, IRD UMI 209 UMMISCO, Yaoundé, Cameroun; Laboratoire International en Recherche Informatique et Mathématiques Appliquées, Equipe Idasco, Yaoundé, Cameroun.
Maurice
M
Tchuente
Assistance Publique des Hôpitaux de Paris, Pédiatrie Générale, Hôpital Robert Debré, Paris, France; Université Paris 7 Denis Diderot, Paris Sorbonne Cité, Paris, France.
Albert
A
Faye
Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun; Equipe 4 (VIH et IST) - INSERM U1018 (CESP), Le Kremlin Bicêtre, France.
Mathurin Cyrille
MC
Tejiokem
D000328:Adult; D000886:Anthropometry; D002163:Cameroon; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000503:physiopathology* / Q000635:transmission; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000503:physiopathology*; D014505:Urban Population