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Does HIV infection modify the relationship between pre-pregnancy body mass index and adverse birth outcomes?
Paediatr Perinat Epidemiol. 2020 Jun 03 [Online ahead of print]PP

Abstract

BACKGROUND

South Africa faces dual epidemics of HIV and obesity; however, little research has explored whether HIV status influences associations between pre-pregnancy body mass index (BMI) and adverse birth outcomes.

OBJECTIVES

To examine associations between pre-pregnancy body mass index (BMI) and adverse birth outcomes, and if they differ by HIV status.

METHODS

We followed HIV-uninfected and -infected pregnant women initiating antiretroviral therapy (ART) from first antenatal visit through delivery. HIV-infected women initiated ART (tenofovir-emtricitabine/lamivudine-efavirenz) in pregnancy. Estimated pre-pregnancy BMI (kg/m2) was categorised as underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0). We used modified Poisson regression to estimate risk ratios (RR) for associations between pre-pregnancy BMI and adverse birth outcomes and explored modification by HIV status.

RESULTS

Among 1116 women (53% HIV-infected), 44% of HIV-uninfected women and 36% of HIV-infected women were classified as obese; 4% of women were underweight. Overall, 12% of infants were delivered preterm (<37 weeks), 10% small for gestational age (SGA, <10th percentile), and 9% large for gestational age (LGA, >90th percentile). Compared to HIV-uninfected women, HIV-infected women on ART had less LGA (5% vs 13%) but more SGA (12% vs 8%), and a similar proportion of preterm (13% vs 11%) infants. Pre-pregnancy BMI was not associated with preterm birth. Among HIV-uninfected women, obesity modestly increased the risk of LGA (RR 1.34, 95% confidence interval [CI] 0.82, 2.19), and underweight modestly elevated the risk of SGA (RR 1.66, 95% CI 0.79, 3.46). These associations were attenuated among HIV-infected women (RR 1.07, 95% CI 0.44, 2.64 for LGA, and RR 1.34, 95% CI 0.49, 3.64 for SGA).

CONCLUSIONS

In this urban African setting of high HIV prevalence, pre-pregnancy obesity was common and did not vary by HIV status. In HIV-uninfected women, obesity increased the risk of LGA and being underweight the risk of SGA, compared with among HIV-uninfected women.

Authors+Show Affiliations

Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. Centre for Infectious Disease Epidemiology and Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. Centre for Infectious Disease Epidemiology and Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.Mailman School of Public Health, ICAP at Columbia University, Columbia University, New York, NY, USA.Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.Department of Obstetrics and Gynaecology, University of Cape Town and New Somerset Hospital, Cape Town, South Africa.Mailman School of Public Health, ICAP at Columbia University, Columbia University, New York, NY, USA. Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. Centre for Infectious Disease Epidemiology and Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32490582

Citation

Bengtson, Angela M., et al. "Does HIV Infection Modify the Relationship Between Pre-pregnancy Body Mass Index and Adverse Birth Outcomes?" Paediatric and Perinatal Epidemiology, 2020.
Bengtson AM, Phillips TK, le Roux SM, et al. Does HIV infection modify the relationship between pre-pregnancy body mass index and adverse birth outcomes? Paediatr Perinat Epidemiol. 2020.
Bengtson, A. M., Phillips, T. K., le Roux, S. M., Brittain, K., Zerbe, A., Madlala, H., Malaba, T., Petro, G., Abrams, E. J., & Myer, L. (2020). Does HIV infection modify the relationship between pre-pregnancy body mass index and adverse birth outcomes? Paediatric and Perinatal Epidemiology. https://doi.org/10.1111/ppe.12688
Bengtson AM, et al. Does HIV Infection Modify the Relationship Between Pre-pregnancy Body Mass Index and Adverse Birth Outcomes. Paediatr Perinat Epidemiol. 2020 Jun 3; PubMed PMID: 32490582.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does HIV infection modify the relationship between pre-pregnancy body mass index and adverse birth outcomes? AU - Bengtson,Angela M, AU - Phillips,Tamsin K, AU - le Roux,Stanzi M, AU - Brittain,Kirsty, AU - Zerbe,Allison, AU - Madlala,Hlengiwe, AU - Malaba,Thokozile, AU - Petro,Gregory, AU - Abrams,Elaine J, AU - Myer,Landon, Y1 - 2020/06/03/ PY - 2019/11/18/received PY - 2020/04/01/revised PY - 2020/04/20/accepted PY - 2020/6/4/entrez KW - HIV KW - body mass index KW - obesity KW - pregnancy KW - pregnancy outcome JF - Paediatric and perinatal epidemiology JO - Paediatr Perinat Epidemiol N2 - BACKGROUND: South Africa faces dual epidemics of HIV and obesity; however, little research has explored whether HIV status influences associations between pre-pregnancy body mass index (BMI) and adverse birth outcomes. OBJECTIVES: To examine associations between pre-pregnancy body mass index (BMI) and adverse birth outcomes, and if they differ by HIV status. METHODS: We followed HIV-uninfected and -infected pregnant women initiating antiretroviral therapy (ART) from first antenatal visit through delivery. HIV-infected women initiated ART (tenofovir-emtricitabine/lamivudine-efavirenz) in pregnancy. Estimated pre-pregnancy BMI (kg/m2) was categorised as underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0). We used modified Poisson regression to estimate risk ratios (RR) for associations between pre-pregnancy BMI and adverse birth outcomes and explored modification by HIV status. RESULTS: Among 1116 women (53% HIV-infected), 44% of HIV-uninfected women and 36% of HIV-infected women were classified as obese; 4% of women were underweight. Overall, 12% of infants were delivered preterm (<37 weeks), 10% small for gestational age (SGA, <10th percentile), and 9% large for gestational age (LGA, >90th percentile). Compared to HIV-uninfected women, HIV-infected women on ART had less LGA (5% vs 13%) but more SGA (12% vs 8%), and a similar proportion of preterm (13% vs 11%) infants. Pre-pregnancy BMI was not associated with preterm birth. Among HIV-uninfected women, obesity modestly increased the risk of LGA (RR 1.34, 95% confidence interval [CI] 0.82, 2.19), and underweight modestly elevated the risk of SGA (RR 1.66, 95% CI 0.79, 3.46). These associations were attenuated among HIV-infected women (RR 1.07, 95% CI 0.44, 2.64 for LGA, and RR 1.34, 95% CI 0.49, 3.64 for SGA). CONCLUSIONS: In this urban African setting of high HIV prevalence, pre-pregnancy obesity was common and did not vary by HIV status. In HIV-uninfected women, obesity increased the risk of LGA and being underweight the risk of SGA, compared with among HIV-uninfected women. SN - 1365-3016 UR - https://www.unboundmedicine.com/medline/citation/32490582/Does_HIV_infection_modify_the_relationship_between_pre-pregnancy_body_mass_index_and_adverse_birth_outcomes L2 - https://doi.org/10.1111/ppe.12688 DB - PRIME DP - Unbound Medicine ER -
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