Risk Factors for Prematurity among Neonates from HIV Positive Mothers in Cameroon

Jean Taguebue, Francisca Monebenimp, Walter Zingg, Valere Mve Koh, Annie H. Atchoumi, Alain Gervaix, Ekoe Tetanye
DOI: 10.4236/wja.2011.11001                

Abstract

Objective: Human immunodeficiency virus (HIV) infection is the most important chronic health condition among women in childbearing age in sub-Saharan Africa. There is sparse data about socio-economic factors in the context with adverse outcome in pregnancy. The objective of the study was to identify such factors for prematurity, low birth weight (LBW) and intrauterine growth retardation (IUGR) in infants born to HIV-positive women in Cameroon. Methods: The study was done in Yaoundé between December 2001 and November 2007. Neonates born to HIV-positive mothers were monitored and clinical data as well as socio-economic factors were tested for association with prematurity, LBW and IUGR. Findings: In total, 264 neonates were analyzed. More prematurity occurred when mothers attended less than 4 prenatal care visits (OR [95% CI]: 2.7 [1.21-6.05]; p=0.015). HIV-classification >1 resulted in more IUGR (OR [95% CI]): 3.15 [1.4-7.4]; p=0.01) and LBW (2.20 [1.1-4.6]; p=0.03). Single women were more likely to attend 4 prenatal care visits or more (OR [CI95%]: 2.4 [1.6-3.4]; p<0.001); higher education resulted in better compliance with anaemia prophylaxis (OR [CI95%]: 3.0 [1.5-5.8]; p=0.002) and antimalaria prophylaxis (OR [CI95%]: 2.1 [1.4-3.3]; p<0.001); and was associated with early HIV diagnosis (p=0.003). Conclusion: Prenatal care improves outcome in pregnancy of HIV-positive women. Single mothers compared to women in family settings are more likely to attend prenatal care visits, and HIV was diagnosed earlier in pregnancy in this population. More effort should be put to address women in family settings to early diagnose HIV and to increase compliance with prenatal care.

Keywords

neonates, HIV, pregnancy, prematurity, low birth weight, intrauterine growth retardation, Cameroon, Africa, education

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	M.C. McCormick, “The contribution of low birth weight to infant mortality and childhood morbidity,” New England Journal of Medicine, Vol. 312, No. 2, 1985, pp. 82-90. doi:10.1056/NEJM198501103120204
[2]	F.W. Oechsli, “Ultrasound fetoscopy and intrauterine growth retardation: two misused fashionable ideas,” Pae- diatr Perinat Epidemiol, Vol. 4, No. 2, 1990, pp. 8-12. doi:10.1111/j.1365-3016.1990.tb00612.x
[3]	H.C. Chase, “Infant mortality and weight at birth: 1960 United States birth cohort,” American Journal of Public Health Nations Health,Vol. 42, NO. 9, 1969, pp. 1618-1628. doi:10.2105/AJPH.59.9.1618
[4]	R.B. Jensen, M. Chellakooty, S. Vielwerth, A. Vaag, T. Larsen and G. Greisen, et al, “Intrauterine growth retardation and consequences for endocrine and cardiovascular diseases in adult life: does insulin-like growth factor-I play a role?” Hormone Research, Vol. 60, No. 3, 2003; pp. 136-148. doi:10.1159/000074515
[5]	R.E. Grunau, M.F. Whitfield and C. Davis, “Pattern of learning disabilities in children with extremely low birth weight and broadly average intelligence,” Archives of Pediatrics & Adolescent Medicine, Vol. 156, No. 6, 2002, pp. 615-620.
[6]	M.S. Kramer, “Determinants of low birth weight: methodo- logical assessment and meta-analysis,” Bull World Health Organ, Vol. 65, No. 5, 1987, pp. 663-737.
[7]	P.B. Bloland, J.J. Wirima, R.W. Steketee, B. Chilima, A. Hightower and J.G. Breman, “Maternal HIV infection and infant mortality in Malawi: evidence for increased mor- tality due to placental malaria infection,” AIDS, Vol. 9, No. 7, pp. 721-726. doi:10.1097/00002030-199507000-00009
[8]	C. Ticconi, M. Mapfumo, M. Dorrucci, N. Naha, E. Tarira and A. Pietropolli, et al, “Effect of maternal HIV and malaria infection on pregnancy and perinatal outcome in Zim- babwe,” Journal of Acquired Immune Deficiency Syndromes, Vol. 34, NO. 3, 2003, pp. 289-294. doi:10.1097/00126334-200311010-00005
[9]	J.G. Ayisi, A.M. van Eijk, F.O. ter Kuile, M.S. Kolczak, J.A. Otieno and A.O. Misore, et al, “The effect of dual infection with HIV and malaria on pregnancy outcome in western Kenya,” AIDS, Vol. 17, No. 4, 2003, pp. 585-594.doi:10.1097/00002030-200303070-00014
[10]	F.O. ter Kuile, M.E. Parise, F.H. Verhoeff, V. Udhayakumar, R.D. Newman and A.M. van Eijk, et al, “The burden of co-infection with human immunodeficiency virus type 1 and malaria in pregnant women in sub-saharan Africa,” American Journal of Tropical Medicine and Hygiene, Vol. 72, No.2, 2004, pp. 41-54.
[11]	J.J. Mosoko and A.N. Affana, “Prevalence du VIH et Facteurs Associes,” Institut National de la Statistique Ministere de la Plani- fication, de la Programmation du Developpement et de l’Amenagement du Territoire Yaounde, Cameroun and ORC Macro Calverton, Maryland, 2005, pp. 293-303.
[12]	P. Brocklehurst and R. French, “The association between ma- ternal HIV infection and perinatal outcome: a systematic review of the literature and meta-analysism,” British Journal Obstetrics and Gynaecology, Vol. 105, No. 8, 1998, pp. 836-848.
[13]	M.L. Dreyfuss, G.I. Msamanga, D. Spiegelman, D.J. Hunter, E.J. Urassa and E. Hertzmark, et al, “Determinants of low birth weight among HIV-infected pregnant women in Tanzania,” American Journal of Clinical Nutrition, Vol. 74, No. 6, 2001, pp. 814-826.
[14]	K. Castetbon, J. Ladner, V. Leroy, M. Chauliac, E. Karita and A. De Clercq, et al, “Low birthweight in infants born to African HIV-infected women: relationship with maternal body weight during pregnancy: Pregnancy and HIV Study Group (EGE),” Journal of Tropical Pediatrics, Vol. 45, No. 3, 1999, pp. 152-7. doi:10.1093/tropej/45.3.152
[15]	M. Bulterys, A. Chao, S. Munyemana, J.B. Kurawige, P. Naw- rocki and P. Habimana, et al, “Maternal human immunodefi- ciency virus 1 infection and intrauterine growth: a pro- spective cohort study in Butare, Rwanda,” Pediatric Infectious Disease Journal, Vol. 13, No. 2, pp. 94-100. doi:10.1097/00006454-199402000-00003
[16]	P. Lepage, P. Msellati, P. Van de Perre, D.G. Hitimana and F. Dabis, “Characteristics of newborns and HIV-1 infection in Rwanda,” AIDS, Vol. 6, No. 8, 1992, pp. 882-883.
[17]	P. Nair, L. Alger, S. Hines, S. Seiden, R. Hebel and J.P. Johnson, “Maternal and neonatal characteristics associated with HIV infection in infants of seropositive women,” Journal of Acquired Immune Deficency Syndromes, Vol. 6, No. 3, 1993, pp. 298-302.
[18]	T.E. Taha, G.A. Dallabetta, J.K. Canner, J.D. Chiphangwi, G. Liomba and D.R. Hoover, et al, “The effect of human im- munodeficiency virus infection on birthweight, and infant and child mortality in urban Malawi,” International journal of Epidemiology, Vol. 24, No. 5, 1995, pp. 1022-1029. doi:10.1093/ije/24.5.1022
[19]	S. Weng, M. Bulterys, A. Chao, C.A. Stidley, A. Dushimimana and E. Mbarutso, et al, “Perinatal human immunodeficiency virus-1 transmission and intrauterine growth: a cohort study in Butare, Rwanda,” Pediatrics, Vol. 102, No. 2, 1998, p. 24. doi:10.1542/peds.102.2.e24
[20]	J.B. Jackson, P. Musoke, T. Fleming, L.A. Guay, D. Bagenda and M. Allen, et al, “Intrapartum and neonatal single-dose nevi- rapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: 18-month follow-up of the HIVNET 012 ran- domised trial,” Lancet, Vol. 362, No. 9387, 2003, pp. 859-868. doi:10.1016/S0140-6736(03)14341-3
[21]	L.O. Lubchenco, C. Hansman and E. Boyd, “Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26 to 42 weeks,” Pediatrics, Vol. 37, No. 3, 1966, pp. 403-408.
[22]	R. Teck, O. Ascurra, P. Gomani, M. Manzi, O. Pasulani and J. Kusamale, et al, “WHO clinical staging of HIV infection and disease, tuberculosis and eligibility for antiretroviral treatment: relationship to CD4 lymphocyte counts,” International Journal of Tuberculosis and Lung Disease, Vol. 9, No. 3, 2005, pp. 258-262.
[23]	J. Schulte, K. Dominguez, T. Sukalac, B. Bohannon and M.G. Fowler, “Declines in low birth weight and preterm birth among infants who were born to HIV-infected women during an era of increased use of maternal antiretroviral drugs: Pediatric Spectrum of HIV Disease, 1989-2004,” Pediatrics, Vol. 119, No. 4, 2007, pp. e900-6. doi:10.1542/peds.2006-1123
[24]	R.C. Andriamady, J.M. Rasamoelisoa, H. Ravaonarivo and R.J. Ranjalahy, “Premature rupture of membranes seen at the Befelatanana maternity, Antananarivo University Hos- pital Center,” Arch Inst Pasteur Madagascar Vol.65, No. 1-2, 1999, pp. 100-102.
[25]	N. Tasnim, G. Mahmud and M.S. Arif, “Impact of reduced prenatal visit frequency on obstetric outcome in low-risk mothers,” Journal of College of Physicians Surgeons Pakistan, Vol. 15, No. 1, 2005, pp. 26-9.
[26]	E.J. Kongnyuy, P.N. Nana, N. Fomulu, S.C. Wiysonge, L. Kouam and A.S. Doh, “Adverse perinatal outcomes of ado- lescent pregnancies in Cameroon,” Maternal and Child Health Journal, Vol. 12, No. 2, 2008, pp. 149-154. doi:10.1007/s10995-007-0235-y
[27]	R.S. McDuffie Jr., A. Beck, K. Bischoff and J. Cross, “Orleans M. Effect of frequency of prenatal care visits on perinatal outcome among low-risk women. A randomized con- trolled trial,” Journal of the American Medical Association, Vol. 275, No. 11, 1996, pp. 847-851. doi:10.1001/jama.275.11.847
[28]	P.H. Rondo, R.F. Ferreira, F. Nogueira, M.C. Ribeiro, H. Lobert and R. Artes, “Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauter- ine growth retardation,” European Journal of Clinical Nutrition, Vol. 57, No. 2, 2003, pp. 266-72. doi:10.1038/sj.ejcn.1601526
[29]	D. Watson-Jones, H.A. Weiss, J.M. Changalucha, J. Todd, B. Gumodoka and J. Bulmer, et al, “Adverse birth outcomes in United Republic of Tanzania--impact and prevention of maternal risk factors,” Bull World Health Organ, Vol. 85, No. 1, 2007, pp. 9-18. doi:10.2471/BLT.06.033258
[30]	M.S. Kramer, “The epidemiology of adverse pregnancy outcomes: an overview,” Journal of Nutrition, Vol. 133, No. 5, Suppl.2, 2003, pp. 1592S-6S.