Determinants of Prenatal Nutritional Status and Adverse Birth Outcomes in HIV-Infected, Pregnant Malawian Women Public Deposited

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  • March 20, 2019
Creator
  • Thomas, Roshan M.
    • Affiliation: Gillings School of Global Public Health, Department of Nutrition
Abstract
  • This research assessed nutritional status and diet of HIV-infected pregnant women who presented for care at public antenatal clinics in Lilongwe, Malawi, and related their nutritional status to birth outcomes. We used data from a large-scaled ongoing Breastfeeding, Antiretroviral, and Nutrition (BAN) Study, a postnatal clinical trial (www.thebanstudy.org). The data used in the analysis was derived from surveys conducted to screen women for BAN study participation and to collect baseline demographic, anthropometric, dietary, and health status data; from antenatal clinic records; and from hospital records at delivery. We found a low linear increase in weight over the second and third trimesters. In addition, in our analysis of weight gain, we found weight loss in the intervals between visits. In unadjusted models, MUAC and AMA increased and AFA declined during late pregnancy. However, based on multivariable regression models, exposure to the famine season resulted in losses in AMA which increased as pregnancy progressed, while AFA losses occurred irrespective of season. In the dietary analysis, three dietary pattern clusters were derived: 1) Cluster 1: high fish, meat and oil, 2) Cluster 2: high grain and 3) Cluster 3: high leafy vegetables, nuts, and fruits. In multiple regression analysis, Cluster 2 had a 1.86 cm2 higher AMA and -2.09 cm2 lower than Cluster 1. Cluster 2 and Cluster 3 both had 0.3 g/dL decreased hemoglobin compared to Cluster 1. In a longitudinal analysis of arm measures and fundal height, as fundal height increased monotonically 0.92 cm/week, AMA was positively associated with fundal height and AFA was negatively associated with fundal height, although these associations were very subtle. Although we identified significant interaction effects of AMA and AFA and week of follow up on fundal height, these effects too were very subtle. We found MUAC, AMA, and AFA collected at the baseline visit were directly associated with newborn's birth weight. MUAC and AMA were both inversely associated with LBW. Our findings contribute to the current understanding of diet, body composition and its effect on birth weight in HIV-infected sub-Saharan women. Strategies to optimize nutrition for HIV-infected women during pregnancy appear warranted.
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  • In Copyright
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  • "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Nutrition, School of Public Health."
Advisor
  • Adair, Linda
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  • Chapel Hill, NC
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  • Open access
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