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Nutritional indicators of adverse pregnancy outcomes and mother-to-child transmission of HIV among HIV-infected women^1,2,3

¹ From the Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA (SM and WWF); the Department of Pediatrics, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania (KPM); the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA (AMY and ERB); the University of North Carolina Project, Lilongwe, Malawi (CC); the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (TET); the Pediatric, Adolescent, and Maternal AIDS Branch, NICHD, NIH, DHHS, Bethesda, MD (JSR); and the Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA (RLG)

Background: Poor nutrition may be associated with mother-to-child transmission (MTCT) of HIV and other adverse pregnancy outcomes.

Objective: The objective was to examine the relation of nutritional indicators with adverse pregnancy outcomes among HIV-infected women in Tanzania, Zambia, and Malawi.

Design: Body mass index (BMI; in kg/m²) and hemoglobin concentrations at enrollment and weight change during pregnancy were prospectively related to fetal loss, neonatal death, low birth weight, preterm birth, and MTCT of HIV.

Results: In a multivariate analysis, having a BMI < 21.8 was significantly associated with preterm birth [odds ratio (OR): 1.82; 95% CI: 1.34, 2.46] and low birth weight (OR: 2.09; 95% CI: 1.41, 3.08). A U-shaped relation between weight change during pregnancy and preterm birth was observed. Severe anemia was significantly associated with fetal loss or stillbirth (OR: 3.67; 95% CI: 1.16, 11.66), preterm birth (OR: 2.08; 95% CI: 1.39, 3.10), low birth weight (OR: 1.76; 95% CI: 1.07, 2.90), and MTCT of HIV by the time of birth (OR: 2.26; 95% CI: 1.18, 4.34) and by 4–6 wk among those negative at birth (OR: 2.33; 95% CI: 1.15, 4.73).

Conclusions: Anemia, poor weight gain during pregnancy, and low BMI in HIV-infected pregnant women are associated with increased risks of adverse infant outcomes and MTCT of HIV. Interventions that reduce the risk of wasting or anemia during pregnancy should be evaluated to determine their possible effect on the incidence of adverse pregnancy outcomes and MTCT of HIV.