Associations between Gestational Anthropometry, Maternal HIV & Fetal & Early Infancy Growth in a Prospective Rural/Semi-Rural Tanzanian Cohort, 2012-13

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.

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.

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.

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.

Below:  Mean weight-for-age and length-for-age z-scores, stratified on infant HIV-exposure or gestational mid-upper arm circumference. Models stratified on infant HIV-exposure (a and b, where “HIV-U” = infant HIV-unexposed, “HIV-E” = infant HIV-exposed) or gestational mid-upper arm circumference (c and d, where “Low MUAC” = lowest gestational mid-upper arm circumference tertile, “High MUAC” = middle and highest tertiles combined). Dotted lines depict z-scores of zero. All models adjusted for gestational age; post hoc pairwise comparisons used to generate predicted marginal means and 95 % CI at each time point. *P < 0.01, **P < 0.001

Below:  Mean weight-for-age and length-for-age z-scores, stratified on infant HIV-exposure plus gestational mid-upper arm circumference. Models stratified on infant HIV-exposure (Fig. 2a and b, where “HIV-U” = infant HIV-unexposed, “HIV-E” = infant HIV-exposed) or gestational mid-upper arm circumference (Fig. 2c and d, where “Low MUAC” = lowest gestational mid-upper arm circumference tertile, “High MUAC” = middle and highest tertiles combined). Dotted lines depict z-scores of zero. All models adjusted for gestational age; post hoc pairwise comparisons were used to generate predicted marginal means and 95 % CI at each time point and the significance threshold after Bonferroni correction; significance was P < 0.01. Significant differences were observed for the following weight-for-age z-scores: -HIV-U/High MUAC vs. HIV-U/Low MUAC at months 2, 3, and 6; -HIV-U/High MUAC vs. HIV-E/High MUAC at months 2 and 3; -HIV-U/High MUAC vs. HIV-E/Low MUAC at each time points. Significant differences were observed for the following length-for-age z-scores: -HIV-U/High MUAC vs. HIV-U/Low MUAC at month 6; -HIV-U/High MUAC vs. HIV-E/Low MUAC at months 3 and 6

Full article at: http://goo.gl/DFOaDt

By: Amanda L. Wilkinson¹, Sarah H. Pedersen¹, Mark Urassa², Denna Michael², Jim Todd³,Safari Kinung’hi², John Changalucha² and Joann M. McDermid^14*

¹Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA

²National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania

³Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK

⁴Present affiliation: Division of Infectious Diseases & International Health, Department of Medicine, School of Medicine, University of Virginia, Charlottesville, VA, USA

  

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