Anemia and Micronutrient Status during Pregnancy, and Their Associations with Obstetric and Infant Outcomes among HIV-Infected Ugandan Women Receiving Antiretroviral Therapy

Julia L. Finkelstein; Heather S. Herman; Albert Plenty; Saurabh Mehta; Paul Natureeba; Tamara D. Clark; Moses R. Kamya; Moses R. Kamya; Theodore Ruel; Edwin D. Charlebois; Edwin D. Charlebois; Deborah Cohan; Diane Havlir; Sera L. Young; Sera L. Young

doi:10.1093/cdn/nzaa075

Anemia and Micronutrient Status during Pregnancy, and Their Associations with Obstetric and Infant Outcomes among HIV-Infected Ugandan Women Receiving Antiretroviral Therapy

Julia L. Finkelstein, Heather S. Herman, Albert Plenty, Saurabh Mehta, Paul Natureeba, Tamara D. Clark, Moses R. Kamya, Moses R. Kamya, Theodore Ruel, Edwin D. Charlebois, Edwin D. Charlebois, Deborah Cohan, Diane Havlir, Sera L. Young^*, Sera L. Young^*

^*Corresponding author for this work

Anthropology

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

Background: Women living with HIV (WLHIV) are at higher risk of micronutrient deficiencies and adverse health outcomes. There are limited data on the burden or sequelae of micronutrient deficiencies among pregnant WLHIV receiving antiretroviral therapy (ART). Objectives: We aimed to examine anemia and vitamin B-12, folate, and vitamin D deficiencies, and their associations with obstetric and infant outcomes, among pregnant WLHIV initiating combination antiretroviral therapy (cART) in rural Uganda. Methods: This was a prospective analysis among pregnant WLHIV (12-28 weeks of gestation) in PROMOTE-Pregnant Women and Infants (PIs), a randomized trial comparing the effects of protease inhibitor (PI)-based ART with those of a non-PI-based ART on placental malaria risk. We conducted a substudy on the burden of anemia [trimester 1/3: hemoglobin (Hb) <11.0 g/dL; trimester 2: Hb <10.5 g/dL; n = 367] and micronutrient deficiencies (n = 127) in pregnant WLHIV and their associations with obstetric and infant outcomes. Hb was measured by cyanmethemoglobin, vitamin B-12 and folate were measured via electrochemiluminescence, and vitamin D was measured by ELISA. Linear and binomial regression were used to evaluate associations between micronutrient status during pregnancy and perinatal outcomes. Results: 26.8% women were anemic, 30.2% were vitamin B-12 insufficient (<221.0 pmol/L), 66.1% were folate insufficient (<13.5 nmol/L), and 65.4% were vitamin D insufficient (<30.0 ng/mL) at enrollment. Anemia during pregnancy was associated with a greater risk of small for gestational age (SGA) (RR: 1.88; 95% CI: 1.28, 2.77; P = 0.001); each 1-g/dL decrease in Hb was associated with greater risk of SGA (RR: 0.76; 95% CI: 0.65, 0.90; P = 0.001). Multivariate models showed that increased vitamin D concentrations predicted lower risk of infant wasting (WLZ <-2; RR: 0.94; 95% CI: 0.89, 0.99; P = 0.04). Multivariate models also indicated that maternal vitamin B-12 and folate concentrations at enrollment predicted maternal (P < 0.001) and infant (P = 0.02) concentrations postpartum. Conclusions: Anemia and micronutrient deficiencies are associated with a variety of adverse obstetric and infant outcomes and are an important public health concern in perinatal WLHIV on cART and their children. This trial was registered at clinicaltrials.gov as NCT00993031.

Original language	English (US)
Article number	nzaa075
Journal	Current Developments in Nutrition
Volume	4
Issue number	5
DOIs	https://doi.org/10.1093/cdn/nzaa075
State	Published - Apr 29 2020

Funding

Copyright ©C The Author(s) on behalf of the American Society for Nutrition 2020. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] Manuscript received December 6, 2019. Initial review completed March 18, 2020. Revision accepted April 9, 2020. Published online April 25, 2020. Supported by the US President’s Emergency Plan for AIDS Relief (to DH), NIH grant P01HD059454 (to DH), and NIH Office of AIDS Research supplemental funding to grants P01HD059454 (to DH) and K01MH098902 (to SLY). Author disclosures: SM is an unpaid board member for a diagnostic start-up focused on measurement of nutritional biomarkers at the point of care utilizing the results from his research. All other authors report no conflicts of interest. The views and conclusions contained herein are those of the authors and should not be interpreted as necessarily representing those of the National Institute of Mental Health or the NIH. Supplemental Table 1 is available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/cdn/. Address correspondence to SLY (e-mail: [email protected]). Abbreviations used: ART, antiretroviral therapy; cART, combination antiretroviral therapy; Hb, hemoglobin; LAZ, length-for-age z score; LMP, last menstrual period; PI, protease inhibitor; SGA, small for gestational age; TS, trimethoprim-sulfamethoxazole; WAZ, weight-for-age z score; WLHIV, women living with HIV; WLZ, weight-for-length z score.

Keywords

AIDS
anemia
folate
micronutrient
postpartum
pregnant
sub-Saharan Africa
vitamin B-12
vitamin D

ASJC Scopus subject areas

Food Science
Nutrition and Dietetics
Medicine (miscellaneous)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/cdn/nzaa075

Cite this

Finkelstein, J. L., Herman, H. S., Plenty, A., Mehta, S., Natureeba, P., Clark, T. D., Kamya, M. R., Kamya, M. R., Ruel, T., Charlebois, E. D., Charlebois, E. D., Cohan, D., Havlir, D., Young, S. L., & Young, S. L. (2020). Anemia and Micronutrient Status during Pregnancy, and Their Associations with Obstetric and Infant Outcomes among HIV-Infected Ugandan Women Receiving Antiretroviral Therapy. Current Developments in Nutrition, 4(5), Article nzaa075. https://doi.org/10.1093/cdn/nzaa075

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title = "Anemia and Micronutrient Status during Pregnancy, and Their Associations with Obstetric and Infant Outcomes among HIV-Infected Ugandan Women Receiving Antiretroviral Therapy",

abstract = "Background: Women living with HIV (WLHIV) are at higher risk of micronutrient deficiencies and adverse health outcomes. There are limited data on the burden or sequelae of micronutrient deficiencies among pregnant WLHIV receiving antiretroviral therapy (ART). Objectives: We aimed to examine anemia and vitamin B-12, folate, and vitamin D deficiencies, and their associations with obstetric and infant outcomes, among pregnant WLHIV initiating combination antiretroviral therapy (cART) in rural Uganda. Methods: This was a prospective analysis among pregnant WLHIV (12-28 weeks of gestation) in PROMOTE-Pregnant Women and Infants (PIs), a randomized trial comparing the effects of protease inhibitor (PI)-based ART with those of a non-PI-based ART on placental malaria risk. We conducted a substudy on the burden of anemia [trimester 1/3: hemoglobin (Hb) <11.0 g/dL; trimester 2: Hb <10.5 g/dL; n = 367] and micronutrient deficiencies (n = 127) in pregnant WLHIV and their associations with obstetric and infant outcomes. Hb was measured by cyanmethemoglobin, vitamin B-12 and folate were measured via electrochemiluminescence, and vitamin D was measured by ELISA. Linear and binomial regression were used to evaluate associations between micronutrient status during pregnancy and perinatal outcomes. Results: 26.8% women were anemic, 30.2% were vitamin B-12 insufficient (<221.0 pmol/L), 66.1% were folate insufficient (<13.5 nmol/L), and 65.4% were vitamin D insufficient (<30.0 ng/mL) at enrollment. Anemia during pregnancy was associated with a greater risk of small for gestational age (SGA) (RR: 1.88; 95% CI: 1.28, 2.77; P = 0.001); each 1-g/dL decrease in Hb was associated with greater risk of SGA (RR: 0.76; 95% CI: 0.65, 0.90; P = 0.001). Multivariate models showed that increased vitamin D concentrations predicted lower risk of infant wasting (WLZ <-2; RR: 0.94; 95% CI: 0.89, 0.99; P = 0.04). Multivariate models also indicated that maternal vitamin B-12 and folate concentrations at enrollment predicted maternal (P < 0.001) and infant (P = 0.02) concentrations postpartum. Conclusions: Anemia and micronutrient deficiencies are associated with a variety of adverse obstetric and infant outcomes and are an important public health concern in perinatal WLHIV on cART and their children. This trial was registered at clinicaltrials.gov as NCT00993031.",

keywords = "AIDS, anemia, folate, micronutrient, postpartum, pregnant, sub-Saharan Africa, vitamin B-12, vitamin D",

author = "Finkelstein, {Julia L.} and Herman, {Heather S.} and Albert Plenty and Saurabh Mehta and Paul Natureeba and Clark, {Tamara D.} and Kamya, {Moses R.} and Kamya, {Moses R.} and Theodore Ruel and Charlebois, {Edwin D.} and Charlebois, {Edwin D.} and Deborah Cohan and Diane Havlir and Young, {Sera L.} and Young, {Sera L.}",

note = "Publisher Copyright: Copyright {\textcopyright} 2020 The Author(s) on behalf of the American Society for Nutrition.",

year = "2020",

month = apr,

day = "29",

doi = "10.1093/cdn/nzaa075",

language = "English (US)",

volume = "4",

journal = "Current Developments in Nutrition",

issn = "2475-2991",

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Finkelstein, JL, Herman, HS, Plenty, A, Mehta, S, Natureeba, P, Clark, TD, Kamya, MR, Kamya, MR, Ruel, T, Charlebois, ED, Charlebois, ED, Cohan, D, Havlir, D, Young, SL & Young, SL 2020, 'Anemia and Micronutrient Status during Pregnancy, and Their Associations with Obstetric and Infant Outcomes among HIV-Infected Ugandan Women Receiving Antiretroviral Therapy', Current Developments in Nutrition, vol. 4, no. 5, nzaa075. https://doi.org/10.1093/cdn/nzaa075

Anemia and Micronutrient Status during Pregnancy, and Their Associations with Obstetric and Infant Outcomes among HIV-Infected Ugandan Women Receiving Antiretroviral Therapy. / Finkelstein, Julia L.; Herman, Heather S.; Plenty, Albert et al.
In: Current Developments in Nutrition, Vol. 4, No. 5, nzaa075, 29.04.2020.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Anemia and Micronutrient Status during Pregnancy, and Their Associations with Obstetric and Infant Outcomes among HIV-Infected Ugandan Women Receiving Antiretroviral Therapy

AU - Finkelstein, Julia L.

AU - Herman, Heather S.

AU - Plenty, Albert

AU - Mehta, Saurabh

AU - Natureeba, Paul

AU - Clark, Tamara D.

AU - Kamya, Moses R.

AU - Ruel, Theodore

AU - Charlebois, Edwin D.

AU - Cohan, Deborah

AU - Havlir, Diane

AU - Young, Sera L.

PY - 2020/4/29

Y1 - 2020/4/29

N2 - Background: Women living with HIV (WLHIV) are at higher risk of micronutrient deficiencies and adverse health outcomes. There are limited data on the burden or sequelae of micronutrient deficiencies among pregnant WLHIV receiving antiretroviral therapy (ART). Objectives: We aimed to examine anemia and vitamin B-12, folate, and vitamin D deficiencies, and their associations with obstetric and infant outcomes, among pregnant WLHIV initiating combination antiretroviral therapy (cART) in rural Uganda. Methods: This was a prospective analysis among pregnant WLHIV (12-28 weeks of gestation) in PROMOTE-Pregnant Women and Infants (PIs), a randomized trial comparing the effects of protease inhibitor (PI)-based ART with those of a non-PI-based ART on placental malaria risk. We conducted a substudy on the burden of anemia [trimester 1/3: hemoglobin (Hb) <11.0 g/dL; trimester 2: Hb <10.5 g/dL; n = 367] and micronutrient deficiencies (n = 127) in pregnant WLHIV and their associations with obstetric and infant outcomes. Hb was measured by cyanmethemoglobin, vitamin B-12 and folate were measured via electrochemiluminescence, and vitamin D was measured by ELISA. Linear and binomial regression were used to evaluate associations between micronutrient status during pregnancy and perinatal outcomes. Results: 26.8% women were anemic, 30.2% were vitamin B-12 insufficient (<221.0 pmol/L), 66.1% were folate insufficient (<13.5 nmol/L), and 65.4% were vitamin D insufficient (<30.0 ng/mL) at enrollment. Anemia during pregnancy was associated with a greater risk of small for gestational age (SGA) (RR: 1.88; 95% CI: 1.28, 2.77; P = 0.001); each 1-g/dL decrease in Hb was associated with greater risk of SGA (RR: 0.76; 95% CI: 0.65, 0.90; P = 0.001). Multivariate models showed that increased vitamin D concentrations predicted lower risk of infant wasting (WLZ <-2; RR: 0.94; 95% CI: 0.89, 0.99; P = 0.04). Multivariate models also indicated that maternal vitamin B-12 and folate concentrations at enrollment predicted maternal (P < 0.001) and infant (P = 0.02) concentrations postpartum. Conclusions: Anemia and micronutrient deficiencies are associated with a variety of adverse obstetric and infant outcomes and are an important public health concern in perinatal WLHIV on cART and their children. This trial was registered at clinicaltrials.gov as NCT00993031.

AB - Background: Women living with HIV (WLHIV) are at higher risk of micronutrient deficiencies and adverse health outcomes. There are limited data on the burden or sequelae of micronutrient deficiencies among pregnant WLHIV receiving antiretroviral therapy (ART). Objectives: We aimed to examine anemia and vitamin B-12, folate, and vitamin D deficiencies, and their associations with obstetric and infant outcomes, among pregnant WLHIV initiating combination antiretroviral therapy (cART) in rural Uganda. Methods: This was a prospective analysis among pregnant WLHIV (12-28 weeks of gestation) in PROMOTE-Pregnant Women and Infants (PIs), a randomized trial comparing the effects of protease inhibitor (PI)-based ART with those of a non-PI-based ART on placental malaria risk. We conducted a substudy on the burden of anemia [trimester 1/3: hemoglobin (Hb) <11.0 g/dL; trimester 2: Hb <10.5 g/dL; n = 367] and micronutrient deficiencies (n = 127) in pregnant WLHIV and their associations with obstetric and infant outcomes. Hb was measured by cyanmethemoglobin, vitamin B-12 and folate were measured via electrochemiluminescence, and vitamin D was measured by ELISA. Linear and binomial regression were used to evaluate associations between micronutrient status during pregnancy and perinatal outcomes. Results: 26.8% women were anemic, 30.2% were vitamin B-12 insufficient (<221.0 pmol/L), 66.1% were folate insufficient (<13.5 nmol/L), and 65.4% were vitamin D insufficient (<30.0 ng/mL) at enrollment. Anemia during pregnancy was associated with a greater risk of small for gestational age (SGA) (RR: 1.88; 95% CI: 1.28, 2.77; P = 0.001); each 1-g/dL decrease in Hb was associated with greater risk of SGA (RR: 0.76; 95% CI: 0.65, 0.90; P = 0.001). Multivariate models showed that increased vitamin D concentrations predicted lower risk of infant wasting (WLZ <-2; RR: 0.94; 95% CI: 0.89, 0.99; P = 0.04). Multivariate models also indicated that maternal vitamin B-12 and folate concentrations at enrollment predicted maternal (P < 0.001) and infant (P = 0.02) concentrations postpartum. Conclusions: Anemia and micronutrient deficiencies are associated with a variety of adverse obstetric and infant outcomes and are an important public health concern in perinatal WLHIV on cART and their children. This trial was registered at clinicaltrials.gov as NCT00993031.

KW - AIDS

KW - anemia

KW - folate

KW - micronutrient

KW - postpartum

KW - pregnant

KW - sub-Saharan Africa

KW - vitamin B-12

KW - vitamin D

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DO - 10.1093/cdn/nzaa075

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C2 - 32440638

AN - SCOPUS:85087449913

SN - 2475-2991

VL - 4

JO - Current Developments in Nutrition

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ER -

Anemia and Micronutrient Status during Pregnancy, and Their Associations with Obstetric and Infant Outcomes among HIV-Infected Ugandan Women Receiving Antiretroviral Therapy

Abstract

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ASJC Scopus subject areas

UN SDGs

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