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Abstract：
BACKGROUND: Outside of pregnancy, evidence shows that persons with HIV initiating or switching to dolutegravir (DTG)-based antiretroviral therapy (ART) experience greater weight gain compared to those on other ART classes. However, there are few data on the impact of DTG-based ART on gestational weight gain (GWG) in sub-Saharan Africa where HIV is most common. According to the National Academy of Medicine (NAM), GWG below and above NAM guidelines is associated with adverse birth outcomes. Therefore, the objective of this study was to describe GWG by HIV status and ART regimen, and examine the associations with adverse birth outcomes.
METHODS: We enrolled pregnant women with HIV (WHIV) and without HIV (≥18 years) in a peri-urban primary healthcare facility in Cape Town, South Africa between 2019 and 2022. GWG was study-measured at 24-28 (baseline) and 33-38 weeks gestation and converted to GWG rate (kg/week) in accordance with NAM guidelines. GWG z-scores were generated using the INTEGROWTH-21 and US standards to account for differing lengths of gestation. Birth outcome data were obtained from medical records. Associations of GWG z-score with adverse birth outcomes were assessed using multivariable linear or log-binomial regression.
RESULTS: Among 292 participants (48% WHIV), median age was 29 years (IQR, 25-33), median pre-pregnancy body mass index (BMI) was 31 kg/m2 (IQR, 26-36) and 20% were primiparous at baseline. The median weekly rate of GWG was 0.30 kg/week (IQR, 0.12-0.50), 35% had GWG below NAM standards (59% WHIV) and 48% had GWG above NAM standards (36% WHIV). WHIV gained weight more slowly (0.25 vs. 0.37 kg/week, p<0.01) than women without HIV. Weekly rate of GWG did not differ by ART regimen (DTG-based ART 0.25 vs. efavirenz-based ART 0.27 kg/week, p = 0.80). In multivariable analyses, GWG z-score was positively associated with continuous birth weight (mean difference = 68.53 95% CI 8.96, 128.10) and categorical high birth weight of >4000 g (RR = 2.18 95% CI 1.18, 4.01).
CONCLUSIONS: Despite slower GWG among WHIV, nearly half of all women gained weight faster than recommended by the NAM. GWG was positively associated with infant birth weight. Interventions to support healthy GWG in sub-Saharan Africa are urgently needed.
METHODS: We enrolled pregnant women with HIV (WHIV) and without HIV (≥18 years) in a peri-urban primary healthcare facility in Cape Town, South Africa between 2019 and 2022. GWG was study-measured at 24-28 (baseline) and 33-38 weeks gestation and converted to GWG rate (kg/week) in accordance with NAM guidelines. GWG z-scores were generated using the INTEGROWTH-21 and US standards to account for differing lengths of gestation. Birth outcome data were obtained from medical records. Associations of GWG z-score with adverse birth outcomes were assessed using multivariable linear or log-binomial regression.
RESULTS: Among 292 participants (48% WHIV), median age was 29 years (IQR, 25-33), median pre-pregnancy body mass index (BMI) was 31 kg/m2 (IQR, 26-36) and 20% were primiparous at baseline. The median weekly rate of GWG was 0.30 kg/week (IQR, 0.12-0.50), 35% had GWG below NAM standards (59% WHIV) and 48% had GWG above NAM standards (36% WHIV). WHIV gained weight more slowly (0.25 vs. 0.37 kg/week, p<0.01) than women without HIV. Weekly rate of GWG did not differ by ART regimen (DTG-based ART 0.25 vs. efavirenz-based ART 0.27 kg/week, p = 0.80). In multivariable analyses, GWG z-score was positively associated with continuous birth weight (mean difference = 68.53 95% CI 8.96, 128.10) and categorical high birth weight of >4000 g (RR = 2.18 95% CI 1.18, 4.01).
CONCLUSIONS: Despite slower GWG among WHIV, nearly half of all women gained weight faster than recommended by the NAM. GWG was positively associated with infant birth weight. Interventions to support healthy GWG in sub-Saharan Africa are urgently needed.
摘要：
背景：在怀孕之外，有证据表明,与接受其他ART治疗的患者相比,开始或转换为基于dolutegravir(DTG)的抗逆转录病毒治疗(ART)患者的体重增加更大.然而,在艾滋病毒最常见的撒哈拉以南非洲,关于基于DTG的ART对妊娠期体重增加(GWG)的影响的数据很少.根据美国国家医学科学院（NAM），低于和高于NAM指南的GWG与不良分娩结局相关。因此,这项研究的目的是通过HIV状况和ART方案描述GWG，并检查与不良分娩结局的关联。
方法：我们在开普敦的城市周边初级医疗机构招募了感染艾滋病毒（WHIV）和未感染艾滋病毒（≥18岁）的孕妇，南非在2019年至2022年之间。根据NAM指南，在妊娠24-28（基线）和33-38周时对GWG进行研究测量，并转换为GWG率（kg/周）。使用INTEGROWTH-21和美国标准产生GWGz评分，以考虑不同的妊娠长度。出生结果数据来自医疗记录。使用多变量线性或对数二项回归评估GWGz评分与不良出生结局的关联。
结果：在292名参与者（48％WHIV）中，中位年龄为29岁(IQR，25-33),中位孕前体重指数(BMI)为31kg/m2(IQR，26-36）和20%是基线时的初产。GWG的每周中位数为0.30千克/周(IQR，0.12-0.50),35％的GWG低于NAM标准（59％WHIV），48％的GWG高于NAM标准（36％WHIV）。WHIV体重增加更慢（0.25vs.0.37公斤/周，p<0.01）比没有艾滋病毒的妇女。GWG的每周比率因ART方案而没有差异（基于DTG的ART0.25与基于efavirenz的ART0.27公斤/周，p=0.80）。在多变量分析中，GWGz评分与连续出生体重（平均差异=68.5395％CI8.96，128.10）和分类高出生体重>4000g（RR=2.1895％CI1.18，4.01）呈正相关。
结论：尽管WHIV中GWG较慢，近一半的女性体重增加速度比NAM建议的要快。GWG与婴儿出生体重呈正相关。迫切需要采取干预措施，以支持撒哈拉以南非洲的健康GWG。
方法：我们在开普敦的城市周边初级医疗机构招募了感染艾滋病毒（WHIV）和未感染艾滋病毒（≥18岁）的孕妇，南非在2019年至2022年之间。根据NAM指南，在妊娠24-28（基线）和33-38周时对GWG进行研究测量，并转换为GWG率（kg/周）。使用INTEGROWTH-21和美国标准产生GWGz评分，以考虑不同的妊娠长度。出生结果数据来自医疗记录。使用多变量线性或对数二项回归评估GWGz评分与不良出生结局的关联。
结果：在292名参与者（48％WHIV）中，中位年龄为29岁(IQR，25-33),中位孕前体重指数(BMI)为31kg/m2(IQR，26-36）和20%是基线时的初产。GWG的每周中位数为0.30千克/周(IQR，0.12-0.50),35％的GWG低于NAM标准（59％WHIV），48％的GWG高于NAM标准（36％WHIV）。WHIV体重增加更慢（0.25vs.0.37公斤/周，p<0.01）比没有艾滋病毒的妇女。GWG的每周比率因ART方案而没有差异（基于DTG的ART0.25与基于efavirenz的ART0.27公斤/周，p=0.80）。在多变量分析中，GWGz评分与连续出生体重（平均差异=68.5395％CI8.96，128.10）和分类高出生体重>4000g（RR=2.1895％CI1.18，4.01）呈正相关。
结论：尽管WHIV中GWG较慢，近一半的女性体重增加速度比NAM建议的要快。GWG与婴儿出生体重呈正相关。迫切需要采取干预措施，以支持撒哈拉以南非洲的健康GWG。
