Early Childhood Growth Parameters in South African Children with Exposure to Maternal HIV Infection and Placental Insufficiency

Mothusi Nyofane; Marinel Hoffman; Helen Mulol; Tanita Botha; Valerie Vannevel; Robert Pattinson; Ute Feucht

doi:10.3390/v14122745

Early Childhood Growth Parameters in South African Children with Exposure to Maternal HIV Infection and Placental Insufficiency

Viruses. 2022 Dec 9;14(12):2745. doi: 10.3390/v14122745.

Authors

Mothusi Nyofane^{1

2

3

4}, Marinel Hoffman^{1

3

4}, Helen Mulol^{3

4

5}, Tanita Botha⁶, Valerie Vannevel^{3

4

7}, Robert Pattinson^{3

4

7}, Ute Feucht^{3

4

5}

Affiliations

¹ Department of Consumer and Food Sciences, University of Pretoria, Pretoria 0002, South Africa.
² Department of Nutrition, National University of Lesotho, Maseru 100, Lesotho.
³ Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa.
⁴ Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa.
⁵ Department of Paediatrics, University of Pretoria, Pretoria 0002, South Africa.
⁶ Department of Statistics, University of Pretoria, Pretoria 0002, South Africa.
⁷ Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria 0002, South Africa.

Abstract

Maternal HIV exposure and intrauterine growth restriction (IUGR) due to placental insufficiency both carry major risks to early child growth. We compared the growth outcomes of children aged 18 months who had abnormal umbilical artery resistance indices (UmA-RI), as a marker of placental insufficiency, with a comparator group of children with normal UmA-RI during pregnancy, as mediated by maternal HIV infection. The cross-sectional study included 271 children, grouped into four subgroups based on HIV exposure and history of normal/abnormal UmA-RI, using available pregnancy and birth information. Standard procedures were followed to collect anthropometric data, and z-scores computed as per World Health Organization growth standards. Lower length-for-age z-scores (LAZ) were observed in children who were HIV-exposed-uninfected (CHEU) (-0.71 ± 1.23; p = 0.004) and who had abnormal UmA-RI findings (-0.68 ± 1.53; p < 0.001). CHEU with abnormal UmA-RI had lower LAZ (-1.3 ± 1.3; p < 0.001) and weight-for-age z-scores (WAZ) (-0.64 ± 0.92; p = 0.014) compared to the control group. The prevalence of stunting was 40.0% in CHEU with abnormal UmA-RI and 16.0% in CHEU with normal UmA-RI (p < 0.001; p = 0.016, respectively). In conclusion, maternal HIV exposure and placental insufficiency are independent risk factors for childhood stunting, with this risk potentiated when these two risk factors overlap.

Keywords: child growth; children who are HIV-exposed-uninfected (CHEU); intrauterine growth restriction; placental insufficiency.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Child, Preschool
Cross-Sectional Studies
Female
Fetal Growth Retardation / epidemiology
Growth Disorders / epidemiology
HIV Infections* / complications
HIV Infections* / epidemiology
Humans
Placenta
Placental Insufficiency* / epidemiology
Pregnancy
South Africa / epidemiology

Grants and funding

This research received funding from the South African Medical Research Council (SAMRC), UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), executed by the WHO and CIPHER funding (International AIDS Society) for the Siyakhula study.