Addressing the Dual Burden of HIV and non-communicable diseases in pregnancy in South Africa

项目摘要 在南非，高达40%的孕妇感染艾滋病毒，30-45%的孕妇肥胖。肥胖女性在 患非传染性疾病（NCDs）的风险较高，如妊娠糖尿病或 妊娠期高血压疾病（如妊娠期高血压、先兆子痫和子痫）。非传染性疾病 怀孕会增加不良妊娠结局的风险，并使妇女和儿童更容易发生 在以后的生活中发展NCD的风险更高，包括肥胖，2型糖尿病和心血管疾病。 怀孕期间的非传染性疾病可能是感染艾滋病毒的妇女特别关切的问题。在未怀孕的成年人中， 某些类型的抗逆转录病毒治疗（ART）会影响肥胖、血脂异常和胰岛素抵抗的发生。 抵抗力，并有助于高血压和2型糖尿病的发展-但艾滋病毒对 非传染性疾病在怀孕期间的发展和影响尚不清楚。对于低收入和中等收入国家， 在南非等国，怀孕期间艾滋病毒和非传染性疾病的双重负担很可能会严重影响孕产妇健康。 儿童健康在未来几年。关于艾滋病毒和非传染性疾病在怀孕期间的关键交叉点的数据是 迫切需要指导制定有效的筛查、转诊和临床管理策略。 因此，我们建议招募200名HIV感染者和200名未感染HIV的女性（N=400），并随访 从怀孕到产后6个月。妇女将接受妊娠糖尿病筛查， 妊娠期高血压疾病。妊娠结局，包括死胎、早产、大-和小- 将在出生时评估胎龄。在产后6个月，我们将评估产妇和NCD 结果包括肥胖，高血压，2型糖尿病和胰岛素抵抗的妇女和婴儿（如果 相关）。本提案的中心目标是就下列方面的负担和影响提供初步证据： 在低收入国家开展艾滋病毒和非传染性疾病研究的能力建设。 我们将通过以下具体目标实现这些目标：1）确定艾滋病毒状况如何影响 妊娠期发生非传染性疾病的风险，定义为妊娠期糖尿病或高血压疾病， 2）比较妊娠期非传染性疾病对妊娠结局以及母婴非传染性疾病的影响 感染艾滋病毒和未感染艾滋病毒的妇女产后6个月的结果; 3）发展网络， * 有能力进一步开展关于怀孕和产后艾滋病毒和非传染性疾病的合作研究， 非洲和美国的机构。能力建设将包括指导研究生，召开研讨会， 关于怀孕期间的非传染性疾病和艾滋病毒，汇集了来自美国和南非的专家， 成立了一个科学咨询委员会，以推进低收入国家非传染性疾病和艾滋病毒围产期研究的优先事项。我们 来自美国和南非的艾滋病毒和非传染性疾病专家组成的多学科小组， 拟议的项目将为未来的建议提供初步数据，并为研究提供一个强大的平台 在艾滋病毒和非传染性疾病方面取得进展，以改善低收入国家的孕产妇和儿童健康。

PROJECT SUMMARY In South Africa, up to 40% of pregnant women are HIV-infected and 30-45% are obese. Obese women are at high risk for developing non-communicable diseases (NCDs), such as gestational diabetes mellitus or a hypertensive disorder in pregnancy (e.g. gestational hypertension, pre-eclampsia and eclampsia). NCDs in pregnancy increase the risk of adverse pregnancy outcomes and predispose both women and children to a higher risk of developing a NCD later in life, including obesity, Type 2 diabetes and cardiovascular disease. NCDs in pregnancy may be of special concern for HIV-infected women. In non-pregnant adults, HIV-infection and some types of antiretroviral therapy (ART) influence the development of adiposity, dyslipidemia, and insulin resistance and contribute to the development of hypertension and Type 2 diabetes – but the impact of HIV on the development and impact of NCDs in pregnancy is not clear. For low- and middle-income countries (LMICs), such as South Africa, the high dual burden of HIV and NCDs in pregnancy is likely to strongly influence maternal and child health in the coming years. Data addressing the critical intersection of HIV and NCDs in pregnancy is urgently needed to guide the development of effective screening, referral, and clinical management strategies. Thus, we propose to enroll a cohort of 200 HIV-infected and 200 HIV-uninfected women (N=400) and follow them from pregnancy through 6 months postpartum. Women will be screened for gestational diabetes and hypertensive disorders in pregnancy. Pregnancy outcomes, including stillbirth, preterm birth, large- and small- for gestational age will be evaluated at birth. At 6 months postpartum we will evaluate maternal and NCD outcomes including obesity, hypertension, Types 2 diabetes and insulin resistance in women and infants (if relevant). The central objective of this proposal is to generate preliminary evidence on the burden and impact of NCDs and HIV in pregnancy and postpartum in LMICs and to build capacity for HIV and NCD research in LMICs. We will accomplish these objectives through the following specific aims: 1) Determine how HIV-status affects the risk of developing NCDs in pregnancy, defined as gestational diabetes or a hypertensive disorder in pregnancy; 2) Compare the impact of NCDs in pregnancy on pregnancy outcomes and maternal and infant NCD outcomes at 6 months postpartum between HIV-infected and HIV-uninfected women; 3) Develop networks and capacity for further collaborative research on HIV and NCDs in pregnancy and postpartum involving South African and US institutions. Capacity building will include mentoring graduate students, convening a symposium on NCDs and HIV in pregnancy that brings together experts from the US and South Africa, and the development of a Scientific Advisory Board to advance NCD and HIV perinatal research priorities in LMICs. Our multidisciplinary team of HIV and NCD experts from the US and South Africa are ideally positioned to carry out the proposed project which will provide preliminary data for future proposals and a robust platform for research on HIV and NCDs to improve maternal and child health in LMICs.