Maternal HIV Status Impacts Infant Size, Study Shows

Pregnant, HIV-positive women living in South Africa on antiretroviral therapy (ART) are more likely to give birth to infants of below average weight and length than women without HIV, with no reported difference in breast milk composition, according to a study recently published in Maternal Child and Nutrition, A group of researchers led by Ute D. Feucht, Ph.D., lead investigator and pediatrics professor at the University of Pretoria in South Africa, compared the socioeconomic backgrounds and physical health of pregnant women with and without HIV, to the measurement data of their infants six weeks and six months postnatal.

Due to the nutrients and antibodies found in breast milk, it is still the recommended source of infant feeding in South Africa by the World Health Organization (WHO) guidelines. HIV-positive mothers planning to breastfeed should be fully antiretroviral therapy adherent.

Previous studies have shown mixed results on the growth trajectory of breastfed infants exposed to but not infected with HIV, but this study suggests socioeconomic and environmental factors during the first 1,000 days of life seem to be more critical to infant development than just breastfeeding.

A six-week-old infant should weigh about 4.5 kilograms (kg) and be around 55 centimeters (cm) long and a six-month-old infant should weigh around 7 kg and be around 65 cm long, according to the WHO.

The results of this study show that at the six-week visit, the weight and length of infants exposed to HIV deviated -0.40 kg and -0.42 cm whereas infants unexposed to HIV deviated 0.02 kg and -0.11 cm. At the six-month visit, the weight and length of HIV-exposed infants deviated -0.33 kg and -0.27 cm while the weight and length of infants unexposed to HIV only deviated 0.28 kg and 0.47 cm.

Mothers’ socioeconomic data was gather using a questionnaire given to 90 pregnant women with HIV and 102 without HIV at clinics in the Tshwane District in the Gauteng Province of South Africa between January 2018 to 2021. When compared with women living without HIV, women living with HIV were older (38 vs. 31), less likely to have graduated high school (52.3% vs. 60.8%) and more likely to be employed (58.4% vs. 51.0%).

Researchers also measured physical factors such mothers’ BMI and hemoglobin levels six weeks and six months postnatally, as well as studied the macronutrients of their breast milk. They found that when compared to pregnant women without HIV, pregnant women living with HIV had less hemoglobin (11.1 vs. 11.9 hemoglobin (g/dL)) and a lower BMI (25.9 vs. 27.3).

These results were compared with the physical measurements of the infants, also taken 6 weeks and 6 months postnatally.

Ute D. Feucht, Ph.D.

“Maternal phenotype was associated with infant size and breast milk protein content, and maternal HIV infection predicted decreased infant size for up to age 6 months,” Feucht wrote in the study. “Research with larger sample sizes and participants on different antiretroviral regimens, especially with the updated first-line regimen, which now includes dolutegravir, is warranted to define the role of maternal phenotype in infant growth trajectories in the context of HIV and, in so doing, to assist targeted strategies that will provide long-term benefits for both mother and child.”