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
By: Amanda L. Wilkinson1, Sarah H. Pedersen1, Mark Urassa2, Denna Michael2, Jim Todd3,Safari Kinung’hi2, John Changalucha2 and Joann M. McDermid14*
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
