Prenatal Nutrition and Adverse Birth Outcomes in HIV-Infected Women in Malawi

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DESCRIPTION (provided by applicant): In sub-Saharan Africa, an estimated 13.5 million women of childbearing age are infected with HIV. When they become pregnant, HIV-infected woman face not only the usual physiological and nutritional demands of pregnancy, but also the extra demands imposed by infection. In settings with a high level of food insecurity and high maternal work loads, women may be unable to consume sufficient high quality food to meet these heightened nutritional needs, leaving them at much greater risk of poor health, faster disease progression and increased risk of poor birth outcomes. Most research related to HIV in pregnancy has focused on antiretroviral strategies to reduce mother to child transmission (MTCT) of HIV. Little attention has been paid to maternal health and nutrition status. The proposed study will describe the patterns and determinants of maternal diet and nutritional status in mid to late pregnancy among HIV-infected women in Lilongwe, Malawi, and relate their diet and nutritional status to birth outcomes, including low birth weight, small-size-for-gestational age at birth (SGA), and preterm births. The study will also evaluate the contribution of a World Food Program food ration given to HIV-infected women, assessing how the food supplement was consumed, whether it enhanced maternal dietary intake and diet quality, and whether it affected nutritional status and birth outcomes. The study will use data from about 1,400 participants in the Breastfeeding, Antiretroviral, and Nutrition (BAN) Study, an ongoing clinical trial to evaluate antiretroviral and nutrition interventions to reduce mother-to-child transmission of HIV during breast-feeding in Lilongwe, Malawi. This work will contribute to our knowledge of factors that affect the health of HIV-infected women and their newborn infants in a resource-constrained setting, and thus inform strategies for nutrition counseling and interventions designed to improve maternal health, survival and birth outcomes. PROPOSAL NARRATIVE The proposed study will describe the patterns and determinants of maternal diet and nutritional status in mid to late pregnancy among HIV-infected women in Lilongwe, Malawi, and relate their diet and nutritional status to birth outcomes, including low birth weight, small-size-for-gestational age at birth (SGA), and preterm births. The study will also evaluate the contribution of a World Food Program food ration given to HIV-infected women, assessing how the food supplement was consumed, whether it enhanced maternal dietary intake and diet quality, and whether it affected nutritional status and birth outcomes.