Maternal breastfeeding and education impact infant growth and development more than in utero HIV/ART exposure in context of universal ART: a prospective study.

Journal

AIDS (London, England)
ISSN: 1473-5571
Titre abrégé: AIDS
Pays: England
ID NLM: 8710219

Informations de publication

Date de publication:
14 Nov 2023
Historique:
medline: 15 11 2023
pubmed: 15 11 2023
entrez: 15 11 2023
Statut: aheadofprint

Résumé

Exposure to HIV and antiretroviral therapy (ART) in utero may influence infant growth and development. Most available evidence predates adoption of universal ART (Option B+ ART regimens). In a recent cohort, we compared growth and development in HIV-exposed uninfected (HEU) to HIV-unexposed (HUU) infants. Prospective cohort study: data from Impact of Maternal HIV on Mycobacterium Tuberculosis Infection among Peripartum Women and their Infants (MiTIPS) in Western Kenya. Women were enrolled during pregnancy. Mother-infant pairs were followed until 24 months postpartum. We used multivariable linear mixed-effects models to compare growth rates (weight-for-age z-score [WAZ] and height-for-age z-score [HAZ]) and multivariable linear regression to compare overall development between HEU and HUU children. About 51.8% (184/355) of the infants were HEU, 3.9% low birthweight (<2.5 kg), and 8.5% preterm (<37 gestational weeks). During pregnancy, all mothers of HEU received ART; 67.9% started ART pre-pregnancy, and 87.3% received 3TC/FTC,TDF,EFV. In longitudinal analyses, HEU children did not differ significantly from HUU in growth or development (p > 0.05 for all). In the combined HEU/HUU cohort, higher maternal education was associated with significantly better growth and development: WAZ (β=0.18 [95% CI:0.01, 0.34]), HAZ (β=0.26 [95% CI:0.04, 0.48], and development (β=0.24 [95% CI:0.02, 0.46]). Breastfeeding was associated with significantly better HAZ (β=0.42 [95% CI:0.19, 0.66]) and development (β=0.31 [95% CI:0.08, 0.53]). HEU children in the setting of universal maternal ART had a similar growth trajectory and development to HUU children. Breastfeeding and maternal education improved children's weight, height, and overall development irrespective of maternal HIV status.

Sections du résumé

BACKGROUND BACKGROUND
Exposure to HIV and antiretroviral therapy (ART) in utero may influence infant growth and development. Most available evidence predates adoption of universal ART (Option B+ ART regimens). In a recent cohort, we compared growth and development in HIV-exposed uninfected (HEU) to HIV-unexposed (HUU) infants.
DESIGN METHODS
Prospective cohort study: data from Impact of Maternal HIV on Mycobacterium Tuberculosis Infection among Peripartum Women and their Infants (MiTIPS) in Western Kenya.
METHODS METHODS
Women were enrolled during pregnancy. Mother-infant pairs were followed until 24 months postpartum. We used multivariable linear mixed-effects models to compare growth rates (weight-for-age z-score [WAZ] and height-for-age z-score [HAZ]) and multivariable linear regression to compare overall development between HEU and HUU children.
RESULTS RESULTS
About 51.8% (184/355) of the infants were HEU, 3.9% low birthweight (<2.5 kg), and 8.5% preterm (<37 gestational weeks). During pregnancy, all mothers of HEU received ART; 67.9% started ART pre-pregnancy, and 87.3% received 3TC/FTC,TDF,EFV. In longitudinal analyses, HEU children did not differ significantly from HUU in growth or development (p > 0.05 for all). In the combined HEU/HUU cohort, higher maternal education was associated with significantly better growth and development: WAZ (β=0.18 [95% CI:0.01, 0.34]), HAZ (β=0.26 [95% CI:0.04, 0.48], and development (β=0.24 [95% CI:0.02, 0.46]). Breastfeeding was associated with significantly better HAZ (β=0.42 [95% CI:0.19, 0.66]) and development (β=0.31 [95% CI:0.08, 0.53]).
CONCLUSION CONCLUSIONS
HEU children in the setting of universal maternal ART had a similar growth trajectory and development to HUU children. Breastfeeding and maternal education improved children's weight, height, and overall development irrespective of maternal HIV status.

Identifiants

DOI: 10.1097/QAD.0000000000003785 PMID: 37967230
pubmed: 37967230
doi: 10.1097/QAD.0000000000003785
pii: 00002030-990000000-00390
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Auteurs

Ashenafi S Cherkos (AS)

Biostatistics and Epidemiology Department, University of North Texas Health Science Center, Fort Worth, Texas, USA.

Sylvia M LaCourse (SM)

Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.
Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA.
Department of Global Health, School of Public Health, University of Washington, Seattle, Washington, USA.

John Kinuthia (J)

Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.
Department of Obstetrics and Gynaecology, Kenyatta National Hospital, Nairobi, Kenya.

Jerphason Mecha (J)

Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.

Daniel A Enquobahrie (DA)

Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.

Jaclyn N Escudero (JN)

Department of Global Health, School of Public Health, University of Washington, Seattle, Washington, USA.

Grace John-Stewart (G)

Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.
Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA.
Department of Global Health, School of Public Health, University of Washington, Seattle, Washington, USA.
Department of Pediatrics, University of Washington, Seattle, Washington, USA.

Classifications MeSH