Early Childhood Growth Parameters in South African Children with Exposure to Maternal HIV Infection and Placental Insufficiency

Viruses. 2022 Dec 9;14(12):2745. doi: 10.3390/v14122745.


Maternal HIV exposure and intrauterine growth restriction (IUGR) due to placental insufficiency both carry major risks to early child growth. We compared the growth outcomes of children aged 18 months who had abnormal umbilical artery resistance indices (UmA-RI), as a marker of placental insufficiency, with a comparator group of children with normal UmA-RI during pregnancy, as mediated by maternal HIV infection. The cross-sectional study included 271 children, grouped into four subgroups based on HIV exposure and history of normal/abnormal UmA-RI, using available pregnancy and birth information. Standard procedures were followed to collect anthropometric data, and z-scores computed as per World Health Organization growth standards. Lower length-for-age z-scores (LAZ) were observed in children who were HIV-exposed-uninfected (CHEU) (-0.71 ± 1.23; p = 0.004) and who had abnormal UmA-RI findings (-0.68 ± 1.53; p < 0.001). CHEU with abnormal UmA-RI had lower LAZ (-1.3 ± 1.3; p < 0.001) and weight-for-age z-scores (WAZ) (-0.64 ± 0.92; p = 0.014) compared to the control group. The prevalence of stunting was 40.0% in CHEU with abnormal UmA-RI and 16.0% in CHEU with normal UmA-RI (p < 0.001; p = 0.016, respectively). In conclusion, maternal HIV exposure and placental insufficiency are independent risk factors for childhood stunting, with this risk potentiated when these two risk factors overlap.

Keywords: child growth; children who are HIV-exposed-uninfected (CHEU); intrauterine growth restriction; placental insufficiency.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Fetal Growth Retardation / epidemiology
  • Growth Disorders / epidemiology
  • HIV Infections* / complications
  • HIV Infections* / epidemiology
  • Humans
  • Placenta
  • Placental Insufficiency* / epidemiology
  • Pregnancy
  • South Africa / epidemiology

Grants and funding

This research received funding from the South African Medical Research Council (SAMRC), UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), executed by the WHO and CIPHER funding (International AIDS Society) for the Siyakhula study.