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

描述(申请人提供)：在撒哈拉以南非洲，估计有1350万育龄妇女感染艾滋病毒。感染艾滋病毒的妇女在怀孕时不仅面临着通常怀孕时的生理和营养需求，而且还面临着感染带来的额外要求。在粮食不安全程度高和产妇工作量大的环境中，妇女可能无法消费足够的高质量食物来满足这些更高的营养需求，从而使她们面临更大的风险，即健康状况不佳、疾病进展更快和出生结果不佳的风险增加。大多数与怀孕期间艾滋病毒有关的研究都集中在减少艾滋病毒母婴传播的抗逆转录病毒战略上。对产妇健康和营养状况的关注很少。这项拟议的研究将描述马拉维利隆圭艾滋病毒感染妇女怀孕中后期的母亲饮食和营养状况的模式和决定因素，并将她们的饮食和营养状况与出生结果联系起来，包括出生体重低、出生时小于胎龄(SGA)和早产。这项研究还将评估世界粮食计划署向艾滋病毒感染妇女提供的食品配给的贡献，评估这种食品补充剂是如何消费的，它是否增加了母亲的膳食摄入量和饮食质量，以及它是否影响了营养状况和生育结果。这项研究将使用来自母乳喂养、抗逆转录病毒和营养(BAN)研究的约1400名参与者的数据，该研究是一项正在进行的临床试验，旨在评估马拉维利隆圭的抗逆转录病毒和营养干预措施，以减少艾滋病毒的母婴传播。这项工作将有助于我们了解在资源有限的情况下影响艾滋病毒感染妇女及其新生儿健康的因素，从而为营养咨询和旨在改善产妇健康、存活率和生育结果的干预措施提供战略。建议书叙事 这项拟议的研究将描述马拉维利隆圭艾滋病毒感染妇女怀孕中后期的母亲饮食和营养状况的模式和决定因素，并将她们的饮食和营养状况与出生结果联系起来，包括出生体重低、出生时小于胎龄(SGA)和早产。这项研究还将评估世界粮食计划署向艾滋病毒感染妇女提供的食品配给的贡献，评估这种食品补充剂是如何消费的，它是否增加了母亲的膳食摄入量和饮食质量，以及它是否影响了营养状况和生育结果。

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.