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PEDIATRICS Vol. 102 No. 2 August 1998, p. e24

ELECTRONIC ARTICLE:
Perinatal Human Immunodeficiency Virus-1 Transmission and Intrauterine Growth: A Cohort Study in Butare, Rwanda

Received Jul 11, 1997; accepted Mar 25, 1998.

Ssu Weng*, Dagger , Marc Bulterys*, Dagger , Ann Chao§, Christine A. Stidley*, Abel Dushimimanaparallel , Etienne Mbarutso, , and Alfred Saah#

From the * Division of Community Medicine, Department of Family and Community Medicine, Dagger  Department of Pediatrics, and § Division of Epidemiology and Preventive Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico; parallel  University Center for Public Health, School of Medicine and  Department of Obstetrics and Gynecology, University Hospital, National University of Rwanda, Butare, Rwanda; and # Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland.

Objective.  To study the association of perinatal human immunodeficiency virus (HIV)-1 transmission with birth outcomes, including birth weight, gestational age, ponderal index, head circumference, and weight/head ratio.

Methods.  Data from a prospective cohort study of 627 pregnant women and their infants in Butare, Rwanda, from October 1989 until April 1994 were analyzed. A total of 318 HIV-1-infected and 309 seronegative women were enrolled during pregnancy and gave birth to 590 live singletons. Multiple linear regression modeling was used to assess the association of mother-child HIV status with several birth outcome measures.

Results.  Unadjusted mean birth weight of HIV- infected infants was 235 g (95% confidence interval [CI] = 94 to 376 g) less than that of HIV-uninfected infants born to HIV-positive mothers (the reference group). After adjustment for gestational age, socioeconomic factors, maternal age, parity, hematocrit, and anthropomorphic measures, mean birth weight of HIV-infected infants was 154 g (95% CI = 38 to 271 g) lower than that of the reference group. When infants born to HIV-seronegative mothers were compared with the reference group, mean birth weights did not differ. Adjusted models resulted in estimates of mean head circumference 0.6 cm smaller (95% CI = 0.2 to 1.1 cm), ponderal index 0.14 lower (95% CI = 0.05 to 0.23), weight/head ratio 3.5 lower (95% CI = 0.5 to 6.4), and gestational age 0.5 weeks shorter (95% CI = 0.1 to 0.9 weeks) for HIV-infected infants than for the reference group.

Conclusions.  After adjustment for potential confounding variables, this study showed statistically significant differences in birth weight, gestational age, ponderal index, and weight/head ratio when HIV-infected infants were compared with noninfected infants born to HIV-positive mothers. HIV-1, mother-to-child transmission, Africa, intrauterine growth, birth weight, gestational age, ponderal index.




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