Mid-thigh circumference as an indicator of nutritional status to predict adverse pregnancy outcomes among HIV-infected and HIV-uninfected women in Malawi

Keerthana Hirudayakanth; Luis Gadama; Sufia Dadabhai; Chaplain Katumbi; Hazzie Mvula; Bonus Makanani; Frank Taulo; Taha E Taha

doi:10.1186/s12884-021-04118-4

Mid-thigh circumference as an indicator of nutritional status to predict adverse pregnancy outcomes among HIV-infected and HIV-uninfected women in Malawi

BMC Pregnancy Childbirth. 2021 Sep 23;21(1):646. doi: 10.1186/s12884-021-04118-4.

Authors

Keerthana Hirudayakanth¹, Luis Gadama², Sufia Dadabhai³, Chaplain Katumbi⁴, Hazzie Mvula⁴, Bonus Makanani², Frank Taulo², Taha E Taha³

Affiliations

¹ Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA. khiruda1@jhu.edu.
² College of Medicine, University of Malawi, Blantyre, Malawi.
³ Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
⁴ College of Medicine-Johns Hopkins Research Project, Blantyre, Malawi.

Abstract

Background: High rates of adverse pregnancy outcomes globally raise the need to understand risk factors and develop preventative interventions. The Pregnancy Outcomes in the Era of Universal Antiretroviral Treatment in Sub-Saharan Africa (POISE Study) was a prospective, observational cohort study conducted from 2016 to 2017 in Blantyre, Malawi. We examine the associations between indicators of nutritional status, specifically mid-thigh circumference (MTC) and body-mass index (BMI), and adverse pregnancy outcomes, low birth weight (LBW), preterm birth (PTB), and small-for-gestational age (SGA), in a cohort of HIV-infected and HIV-uninfected women.

Methods: Sociodemographic, clinical, laboratory, and maternal height, weight and MTC data were collected immediately before or after delivery at the Queen Elizabeth Central Hospital (QEHC) and 4 affiliated health centers in Blantyre, Malawi. LBW was defined as birth weight < 2.5 kg; PTB as gestational age < 37 weeks using Ballard score; and SGA as birth weight < 10th percentile for gestational age. Descriptive, stratified, and multivariable logistic regression were conducted using R.

Results: Data from 1298 women were analyzed: 614 HIV-infected and 684 HIV-uninfected. MTC was inversely associated with LBW (adjusted odds ratio [aOR] = 0.95, p = 0.03) and PTB (aOR 0.92, p < 0.001), after controlling for HIV status, age, socioeconomic status and hemoglobin. The association between MTC and SGA was (aOR 0.99, p = 0.53). Similarly, higher BMI was significantly associated with lower odds of PTB (aOR 0.90, p < 0.001), LBW (aOR 0.93, p = 0.05), and SGA (aOR 0.95, p = 0.04).

Conclusions: We observed an inverse relationship between MTC and adverse pregnancy outcomes in Malawi irrespective of HIV infection. MTC performs comparably to BMI; the ease of measuring MTC could make it a practical tool in resource-constrained settings for identification of women at risk of adverse pregnancy outcomes.

Keywords: Body-mass index; HIV infection; Malawi; Maternal anthropometry; Mid-thigh circumference; Pregnancy outcomes.

Publication types

Comparative Study
Observational Study

MeSH terms

Adult
Body Size / physiology*
Female
Gestational Age
HIV Infections
Humans
Infant, Low Birth Weight
Infant, Newborn
Malawi / epidemiology
Male
Nutritional Status / physiology*
Pregnancy
Pregnancy Complications / epidemiology*
Pregnancy Outcome / epidemiology
Premature Birth / epidemiology
Prospective Studies
Thigh* / physiology
Young Adult