ArticleBMC pregnancy and childbirth2021
Lower birth weight-for-age and length-for-age z-scores in infants with in-utero HIV and ART exposure: a prospective study in Cape Town, South Africa.
Article in BMC pregnancy and childbirth, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Perinatal outcomes in women living with HIV-1 and receiving antiretroviral therapy-a systematic review and meta-analysis.Acta obstetricia et gynecologica Scandinavica · 2022Pooled it
- In-utero HIV exposure and postnatal growth to 8 years of age: a prospective cohort study in the Western Cape, South Africa.The Lancet. Child & adolescent health · 2026Article
- Article
- Association between infant feeding practices and infant growth by maternal HIV and antiretroviral therapy status: a prospective study in Cape Town, South Africa.BMC pregnancy and childbirth · 2026Article
- Effects of HIV exposure on anemia and vitamin D nutritional status in children aged 6-24 months: a hospital-based cross-sectional study.Scientific reports · 2025Article
- Growth Trajectories Over the First Year of Life Among Early-Treated Infants with Human Immunodeficiency Virus and Infants Who are Human Immunodeficiency Virus-Exposed Uninfected.The Journal of pediatrics · 2024Article
- Review
- Bifidobacterium infantis supplementation versus placebo in early life to improve immunity in infants exposed to HIV: a protocol for a randomized trial.BMC complementary medicine and therapies · 2023Article
- Achieving equity for children and adolescents with perinatal HIV exposure: an urgent need for a paradigm shift.Journal of the International AIDS Society · 2023Article
- Neurodevelopment among children exposed to HIV and uninfected in sub-Saharan Africa.Journal of the International AIDS Society · 2023Article
- Neurodevelopment of children who are HIV-exposed and uninfected in Kenya.Journal of the International AIDS Society · 2023Article
- The impact of HIV and ART exposure during pregnancy on fetal growth: a prospective study in a South African cohort.BMC pregnancy and childbirth · 2023Article
- A 12-month Prospective Study of HIV-infected and HIV-uninfected Women and Their Infants in Malawi: Comparative Analysis of Clinical Events and Infant Growth.The American journal of tropical medicine and hygiene · 2023Article
- Impact of antenatal antiretroviral drug exposure on the growth of children who are HIV-exposed uninfected: the national South African Prevention of Mother to Child Evaluation cohort study.BMC infectious diseases · 2022Article
- Dynamics of the infant gut microbiota in the first 18 months of life: the impact of maternal HIV infection and breastfeeding.Microbiome · 2022Article
- Growth patterns of infants with in- utero HIV and ARV exposure in Cape Town, South Africa and Lusaka, Zambia.BMC public health · 2022Observational
- A comparison of weight gain between HIV exposed uninfected and HIV unexposed uninfected infants who received KMC at Chris Hani Baragwanath Academic Hospital.Frontiers in pediatrics · 2022Article
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Authors and funding
9 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundSuccessful scale-up of antiretroviral therapy (ART) during pregnancy has minimized infant HIV acquisition, and over 1 million infants are born HIV-exposed but uninfected (HEU), with an increasing proportion also exposed in utero to maternal ART. While benefits of ART in pregnancy outweigh risks, some studies have reported associations between in utero ART exposure and impaired fetal growth, highlighting the need to identify the safest ART regimens for use in pregnancy.
methodsWe compared birth anthropometrics of infants who were HEU with those HIV-unexposed (HU) in Cape Town, South Africa. Pregnant women had gestational age assessed by ultrasound at enrolment. Women living with HIV were on ART (predominately tenofovir-emtricitabine-efavirenz) either prior to conception or initiated during pregnancy. Birth weights and lengths were converted to weight-for-age (WAZ) and length-for-age (LAZ) z-scores using Intergrowth-21st software. Linear regression was used to compare mean z-scores adjusting for maternal and pregnancy characteristics.
resultsAmong 888 infants, 49% (n = 431) were HEU and 51% (n = 457) HU. Of 431 HEU infants, 62% (n = 268) were exposed to HIV and antiretrovirals (ARVs) from conception and 38% (n = 163) were exposed to ARVs during gestation but after conception (median fetal ARV exposure of 21 weeks [IQR; 17-26]). In univariable analysis, infants who were HEU had lower mean WAZ compared with HU [β = - 0.15 (95% Confidence Interval (CI): - 0.28, - 0.020)]. After adjustment for maternal age, gravidity, alcohol use, marital and employment status the effect remained [adjusted β - 0.14 (95%CI: - 0.28, - 0.01]. Similar differences were noted for mean LAZ in univariable [β - 0.20 (95%CI: - 0.42, - 0.01] but not multivariable analyses [adjusted β - 0.18 (95%CI: - 0.41, + 0.04] after adjusting for the same variables. Mean WAZ and LAZ did not vary by in utero ARV exposure duration among infants who were HEU.
conclusionIn a cohort with high prevalence of ART exposure in pregnancy, infants who were HEU had lower birth WAZ compared with those HU. Studies designed to identify the mechanisms and clinical significance of these disparities, and to establish the safest ART for use in pregnancy are urgently needed.
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