Causal Effect of Maternal HIV on Child Health Outcomes in the Context of Prevention of Mother to Child HIV Transmission (PMTCT) in Malawi

Abstract Evidence has shown that maternal HIV infection has adverse effects on child birth weight. However, the effect of anti-retroviral therapy (ART) on pregnancy outcome is not conclusive. Ascertaining causality of these associations remain largely unexamined and untested, and if confirmed would help policy makers to improve implementation and sensitization of PMTCT program. However, assessing causal effect has been limited due to ethical concerns if randomized controlled trials are appropriate. We aim to estimate the causal effect of maternal HIV on birth weight and the causal effect of knowledge of HIV status on exclusive breastfeeding while ascertaining the mediating effect of ART using observational data. Data on over 18,000 and 16,000 children still alive and born within five years of the 2010 and 2015-16 Malawi Demographic and Health Surveys were analysed. A set of methods for confounder balance namely, the 1:1 nearest neighbour (NN) matching, matching on the propensity score (PS) and inverse weighting the propensity score (PS) were used. Before matching, place of residence, region, anaemia level and age were statistically different between HIV-infected and HIV-uninfected mothers for both the 2010 and 2015-16 data. After matching, the selected confounding variables were distributed similarly between HIV-infection statuses. Maternal HIV infection had a negative effect on infant birth weight for the 2010 data and had a positive effect on birth weight for the 2015-16 data with p-values <0.001. Uptake of ART did not mediate the effect of HIV infection on birth weight. Maternal knowledge of HIV status was not associated with behaviour concerning exclusive breastfeeding. We have found conflicting evidence on the association between maternal HIV infection and birth weight. The adverse association between maternal HIV infection and child birth weight found for the 2010 data could more likely be causal. However, the increased birth weight among infants born to HIV infected mothers in 2015-16 may show the recent successes of policies and interventions within the PMTCT program in Malawi. However, the purported mediating effect of ART on the association between HIV infection and birth weight was not found. Prenatal care interventions should continue to be supported among ANC clinics in Malawi.

Download Full-text

Assessing the Effects of Maternal HIV Infection on Child Birth Weight and Knowledge of HIV status on Breastfeeding using Observational Data in Malawi

10.21203/rs.2.21290/v1 ◽

2020 ◽

Author(s):

Halima Sumayya Twabi ◽

Samuel O Manda ◽

Dylan S Small

Keyword(s):

Adverse Effect ◽

Birth Weight ◽

Propensity Score ◽

Hiv Infection ◽

Exclusive Breastfeeding ◽

Hiv Status ◽

Inverse Weighting ◽

Maternal Hiv ◽

Maternal Hiv Infection ◽

Infant Birth

Abstract Background : Evidence has shown that maternal HIV infection has adverse effect on pregnancy outcomes including childbirth weight and that knowledge of mothers HIV status affects practice of exclusive breastfeeding for the first six month. Using methods for matching possible confounders, the purpose of this study were twofold: a) to assess whether or not the association of maternal HIV on childbirth weight was moderated by use of ART drugs and b) to determine if indeed knowledge of HIV status among mothers was associated with exclusive breastfeeding. Methods: Data on over 18,000 and 16,000 children still alive and born within five years of the 2010 and 2015-16 Malawi Demographic and Health Surveys (MDHS) were analysed. A set of methods for confounder balance namely, the 1:1 nearest neighbour (NN) matching, matching on the propensity score (PS) and inverse weighting the propensity score (PS) were used. Results: Using the 2010 data, maternal HIV infection had a negative effect on infant birth weight -149.0 (-324.2, -26.2) and -154.3 (-295.4, -13.3), under PS matching and PS inverse weighting respectively. Infant birth weights from HIV-infected mothers on ART and uninfected mothers were the same (mean: 3121.3, 95% CI: 3021.9, 3220.7) and (3273.7, 95% CI: 3259.1, 3288.3), respectively) and differed significantly from those HIV-infected mothers (3193.9, 95% CI: 3122.2, 3265.6). For the 2015-16 data, mothers who were HIV-infected gave birth to infants who significantly weighted more than infants from HIV-uninfected mothers 144.7 (40.4, 249.1) and 115.4 (11.6, 219.2), under PS matching and PS inverse weighting respectively. Knowledge of HIV status among mothers was not associated with their behaviour concerning exclusive breastfeeding for the 2010 and 2015-16 data. Conclusion: The association between maternal HIV infection and birth weight depended on the data used, with the 2010 data showing adverse effect. The higher birth weight among infants born to HIV infected mothers in 2015-16 maybe indicative of successes of policies and interventions within the PMTCT program in Malawi. The observed mitigating effect of ART usage by HIV infected mothers on child birth weight further confirms that PMTCT interventions should continue to be supported among antenatal clinics in Malawi.

Download Full-text

Obstetric and new born outcome in HIV infected pregnant women: a prospective cohort study in Bangalore Medical College Hospitals, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184486 ◽

2018 ◽

Vol 7 (11) ◽

pp. 4445

Author(s):

Rashmi S. Desai ◽

Geetha Shivamurthy ◽

Sameer Desai

Keyword(s):

Cohort Study ◽

Birth Weight ◽

Hiv Infection ◽

Pregnant Women ◽

Opportunistic Infection ◽

Prospective Cohort ◽

Premature Rupture ◽

Maternal Hiv ◽

Maternal Hiv Infection ◽

Cd4 Cell

Background: The effect of HIV on obstetric complications is known to vary across regions of world. The variation may be due to HIV infection per se or it may be due to complex interaction of related medical and social conditions that affect pregnancy. Incidence of these obstetric complications in HIV infected pregnant women is not well reported in India. So, this prospective cohort study was carried to observe the demographics and incidence of obstetrics complications like abortions, still birth, premature rupture of membranes, preterm delivery, opportunistic infections in HIV infected pregnant women.Methods: All pregnant women who were screened positive for HIV test, irrespective of their gestational age were included in the study. Apart from routine obstetric care, CD4 cell count was carried out. The patients were followed up till term, delivery and up to 6-week postpartum period. Obstetric outcomes like incidence of abortion, intrauterine death, preterm delivery and premature rupture of membrane were noted. Baby`s birth weight and the incidence of maternal opportunistic infection were noted and correlated with maternal CD4 cell count.Results: Maternal HIV infection is associated pre-term labour in 34.5%, PROM in 30%, low birth weight in 52.3%. Increased incidences of these adverse outcomes have an inverse relationship with CD4 count.Conclusions: Maternal HIV infection is associated with increased incidence of adverse obstetric outcome and opportunistic infection, and their incidences increase with lower CD4 count.

Download Full-text

In Kenya, Maternal HIV Infection Is Associated With Low Birth Weight

International Family Planning Perspectives ◽

10.2307/2133519 ◽

1994 ◽

Vol 20 (3) ◽

pp. 119 ◽

Cited By ~ 1

Author(s):

S. Edwards

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Hiv Infection ◽

Maternal Hiv ◽

Maternal Hiv Infection

Download Full-text

Effect of Maternal HIV Infection on Treatment with HAART on Neonatal Birth Weight and Other Anthropometry: A Cohort Study of HIV Sero-Positive Women in Enugu, South-East Nigeria

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2019/42918.13361 ◽

2019 ◽

Author(s):

Emeka Ifeanyi Iloghalu ◽

Cyril Chukwudi Dim ◽

Emmanuel Onyebuchi Ugwu ◽

Chidinma Ifechi Onwuka ◽

Benjamin Chukwuma Ozumba

Keyword(s):

Cohort Study ◽

Birth Weight ◽

Hiv Infection ◽

Neonatal Birth Weight ◽

Maternal Hiv ◽

Maternal Hiv Infection

Download Full-text

Maternal HIV infection and preeclampsia increased risk of low birth weight among newborns delivered at University of Gondar specialized referral hospital, Northwest Ethiopia, 2017

Italian Journal of Pediatrics ◽

10.1186/s13052-019-0608-z ◽

2019 ◽

Vol 45 (1) ◽

Cited By ~ 3

Author(s):

Daniale Tekelia Ekubagewargies ◽

Destaye Guadie Kassie ◽

Wubet Worku Takele

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Hiv Infection ◽

Northwest Ethiopia ◽

Referral Hospital ◽

Increased Risk ◽

Maternal Hiv ◽

Maternal Hiv Infection

Download Full-text

Assessing the Effects of Maternal HIV Infection on Pregnancy Outcomes using Cross-sectional Data in Malawi

10.21203/rs.2.21290/v2 ◽

2020 ◽

Author(s):

Halima Sumayya Twabi ◽

Samuel O Manda ◽

Dylan S Small

Keyword(s):

Birth Weight ◽

Hiv Infection ◽

Perinatal Mortality ◽

Pregnancy Outcomes ◽

Demographic And Health Surveys ◽

Cross Sectional ◽

Hiv Test ◽

Maternal Hiv ◽

Maternal Hiv Infection ◽

Adverse Pregnancy

Abstract Background : Several studies have shown that maternal HIV infection is associated with adverse pregnancy outcomes such as low birth weight and perinatal mortality. However, the association is conflicted with the effect of antiretroviral therapy (ART) on the pregnancy outcomes and it remains unexamined. Using methods for matching possible confounders, the objectives of the study were to assess the effect of maternal HIV on birth weight and perinatal mortality and to investigate the effect of ART on these two pregnancy outcomes in HIV-infected women. Methods: Data on 4111 and 4759 children, born within five years of the 2010 and 2015-16 Malawi Demographic and Health Surveys (MDHS) respectively, whose mothers had an HIV test result, were analysed. A best balancing method was chosen from a set of covariate balance methods namely, the 1:1 nearest neighbour (NN) matching, matching on the propensity score (PS) and inverse weighting on the PS. HIV and ART data were only available in the MDHS 2010, permitting an assessment of the moderating effect of ART on the association between maternal HIV infection and birth weight and perinatal mortality. Results: In 2010, maternal HIV infection was negatively associated with birth weight (-25.3g, 95% CI:(-95.5, -7.4)) and in 2015-16 it was positively associated with birth weight (116.3g, 95 % CI:(27.8, 204.7)). Perinatal mortality was higher in infants of HIV-infected mothers compared to infants of HIV-uninfected mothers (OR = 1.5, 95% CI:(1.1 - 3.1)) in 2010, while there was no difference in the rate in 2015-16 (OR = 1.0, 95% CI:(0.4, 1.6)). ART was not associated with birth weight, however, it was associated with perinatal mortality (OR=3.9, 95% CI:(1.1, 14.8)). Conclusion: The study has found that maternal HIV infection had an adverse effect on birth weight and perinatal mortality in 2010. Birth weight was not dependent on ART uptake but perinatal mortality was higher among infants of HIV-infected mothers who were not on ART. The higher birth weight among HIV-infected mothers and similarity in perinatal mortality with HIV-uninfected mothers in 2015-16 may be indicative of successes of interventions within the PMTCT program in Malawi.

Download Full-text