title: Associations between gestational anthropometry, maternal HIV, and fetal and early infancy growth in a prospective rural/semi-rural Tanzanian cohort, 2012-13.
abstract: BACKGROUND
  Healthcare access and resources differ considerably between urban and rural settings making cross-setting generalizations difficult. In resource-restricted rural/semi-rural environments, identification of feasible screening tools is a priority. The objective of this study was to evaluate gestational anthropometry in relation to birth and infant growth in a rural/semi-rural Tanzanian prospective cohort of mothers and their infants.
  
  
  METHODS
  Mothers (n = 114: 44 HIV-positive) attending antenatal clinic visits were recruited in their second or third trimester between March and November, 2012, and followed with their infants through 6-months post-partum. Demographic, clinical, and infant feeding data were obtained using questionnaires administered by a Swahili-speaking research nurse on demographic, socioeconomic, clinical, and infant feeding practices. Second or third trimester anthropometry (mid-upper arm circumference [MUAC], triceps skinfold thickness, weight, height), pregnancy outcomes, birth (weight, length, head circumference) and infant anthropometry (weight-for-age z-score [WAZ], length-for-age z-score [LAZ]) were obtained. Linear regression and mixed effect modeling were used to evaluate gestational factors in relation to pregnancy and infant outcomes.
  
  
  CONCLUSIONS
  Gestational MUAC and maternal HIV status (HIV-positive mothers = 39%) were associated with infant WAZ and LAZ from birth to 6-months in multivariate models, even after adjustment for infant feeding practices. The lowest gestational MUAC tertile was associated with lower WAZ throughout early infancy, as well as lower LAZ at 3 and 6-months. In linear mixed effects models through 6-months, each 1 cm increase in gestational MUAC was associated with a 0.11 increase in both WAZ (P < 0.001) and LAZ (P = 0.001). Infant HIV-exposure was negatively associated with WAZ (β = -0.65, P < 0.001) and LAZ (β = -0.49, P < 0.012) from birth to 6-months.
  
  
  CONCLUSIONS
  Lower gestational MUAC, evaluated using only a tape measure and minimal training that is feasible in non-urban clinic and community settings, was associated with lower infant anthropometric measurements. In this rural and semi-rural setting, HIV-exposure was associated with poorer anthropometry through 6-months despite maternal antiretroviral access. Routine assessment of MUAC has the potential to identify at-risk women in need of additional health interventions designed to optimize pregnancy outcomes and infant growth. Further research is needed to establish gestational MUAC reference ranges and to define interventions that successfully improve MUAC during pregnancy.
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA. alw252@cornell.edu.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Wilkinson
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA. sp729@cornell.edu.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Pedersen
authors.affiliation: National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania. urassamark@yahoo.co.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Urassa
authors.affiliation: National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania. dennamichael@gmail.com.
authors.forename: Denna
authors.initials: D
authors.lastname: Michael
authors.affiliation: Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK. jim.todd@lshtm.ac.uk.
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
authors.affiliation: National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania. kinunghi_csm@hotmail.com.
authors.forename: Safari
authors.initials: S
authors.lastname: Kinung'hi
authors.affiliation: National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania. jchangalucha@yahoo.com.
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA. jm3xc@virginia.edu.|Present affiliation: Division of Infectious Diseases & International Health, Department of Medicine, School of Medicine, University of Virginia, Charlottesville, VA, USA. jm3xc@virginia.edu.
authors.forename: Joann M
authors.initials: JM
authors.lastname: McDermid
mesh_terms: D000328:Adult; D000886:Anthropometry; D001724:Birth Weight; D001835:Body Weight; D002657:Child Development; D005260:Female; D047109:Fetal Development; D015658:HIV Infections / Q000150:complications* / Q000635:transmission; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D016014:Linear Models; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D011256:Pregnancy Outcome; D011264:Pregnancy Trimesters / Q000502:physiology*; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D013636:Tanzania