Lipid based nutrient supplements during pregnancy may improve foetal growth in HIV infected women - A cohort study

PLoS One. 2019 May 2;14(5):e0215760. doi: 10.1371/journal.pone.0215760. eCollection 2019.

Abstract

Objectives: Both maternal HIV infection and antiretroviral therapy are associated with adverse birth outcomes. The role of antenatal nutrient supplements with regard to adverse birth outcomes in HIV infected women exposed to antiretroviral therapy is not well known. We assessed the association between HIV and birth outcomes and explored whether antenatal lipid-based nutrient supplements (LNS) modulated this association.

Methods: We analysed a nested cohort of pregnant Malawian women who received daily LNS, multiple micronutrients (MMN) or iron and folic acid (IFA). Birth weight, length-for-age z-score (LAZ) and weight-for-age z-score (WAZ) were analysed as continuous outcomes and proportion of stunting and small-for-gestational age (SGA) as dichotomous outcomes.

Results: 134 HIV infected (46 LNS, 39 MMN, 49 IFA) and 833 HIV uninfected (271 LNS, 287 MMN, 275 IFA) women were included. Maternal HIV infection was associated with a lower mean birth weight (-129g (-209, -48), P = 0.002); LAZ (-0.34 (-0.54, -0.13), P = 0.002) and WAZ (-0.21 (-0.40, -0.02), P = 0.041) and a higher risk of stunting (RR (95% confidence interval), 1.87 (1.24, 2.83), P = 0.003) and SGA (1.66 (1.21, 2.26), P = 0.001) in the newborn. If the women received LNS, HIV was not associated with LAZ (mean difference (95%); -0.02 (-0.35, 0.31), P = 0.918) or newborn stunting (RR (95% CI), 0.84 (0.34, 2.03), P = 0.691). However HIV tended to be associated with LAZ if the women received MMN (-0.42 (-0.80, -0.03), P = 0.053); and was significantly associated with LAZ if the women received IFA (-0.52 (-0.89, -0.14), P = 0.021) and with newborn stunting if they received MMN (2.40 (1.15, 4.98), P = 0.029) or IFA (2.40 (1.26, 4.59), P = 0.024).

Conclusions: Further research to investigate the impact of LNS on various aspects of foetal growth in HIV infected women is warranted.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Body Weight / drug effects
  • Cohort Studies
  • Dietary Supplements*
  • Female
  • Fetal Development / drug effects*
  • HIV Infections* / metabolism
  • HIV Infections* / physiopathology
  • Humans
  • Lipids / chemistry*
  • Lipids / pharmacology*
  • Oxidative Stress / drug effects
  • Pregnancy

Substances

  • Lipids

Grants and funding

This publication is based on research funded in part by the Office of Health, Infectious Diseases, and Nutrition, Bureau for Global Health, U.S. Agency for International Development (USAID) under terms of Cooperative Agreement No. AID-OAA-A-12-00005, through the Food and Nutrition Technical Assistance III Project (FANTA), managed by FHI 360, with additional funding from a grant to the University of California, Davis by the Bill & Melinda Gates Foundation, OPP49817 to KGD. For data management and statistical analysis, the team received additional support in grants from the Academy of Finland (grant 252075) and the Medical Research Fund of Tampere University Hospital (grant 9 M004). The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the United States Government, USAID, the Bill & Melinda Gates Foundation, or the other funders. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.