Masters Degrees (Human Nutrition)

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Browsing Masters Degrees (Human Nutrition) by browse.metadata.advisor "Delport, Suzanne Dirkie"

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    Breastmilk composition of HIV-infected mothers receiving antiretroviral therapy who gave birth to premature infants
    (Stellenbosch : Stellenbosch University, 2016-03) Fouche, Carike; Van Niekerk, Evette; Du Plessis, Lisanne Monica; Delport, Suzanne Dirkie; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
    ENGLISH SUMMARY : Background: The incidence of premature birth is rising in Southern Africa. Premature birth is associated with, among other, human immunodeficiency virus (HIV)-infection during pregnancy. Women with HIV, chronic malnutrition and obesity are more likely to give birth to premature infants with intra-uterine growth restriction (IUGR). Providing the HIV-exposed premature infant with breastmilk accompanied by maternal and infantile anti-retroviral therapy (ART) are key strategies to reduce HIV mother-to-child-transmission (MTCT), and infant morbidity and - mortality. Recent literature showed a difference in the breastmilk composition of HIV-infected and HIV-uninfected mothers. The effects of HIV infection and ART on the breastmilk composition of mothers of premature infants are, however, largely unknown. Aims and Objectives: The main aim of the study was to assess and compare the breastmilk composition of HIV-infected mothers receiving ART and HIV-uninfected mothers who gave birth to premature infants. Secondary objectives of the study were to assess the maternal nutritional status of HIV-infected and HIV-uninfected mothers as well as to assess the neonatal nutritional status of premature infants in relation to maternal nutritional status, HIV status and ART regimen. Participants and Methods: The study was designed as a cross-sectional, descriptive study with an analytical component. Study participants included HIV-infected and HIV-uninfected mothers who gave birth to premature infants. The women were subdivided into four groups according to HIV-status and the length of gestation. Mothers provided demographic information and two breastmilk samples on day seven and nine of lactation. Maternal anthropometric data [weight, height and mid-upper arm circumference (MUAC)] were collected on day seven postpartum. Infant anthropometric data [weight, length and head circumference (HC)] were obtained at birth and length and HC data were obtained once more on day seven postpartum. Breastmilk samples were analysed for energy, protein, carbohydrates, fat, phosphate, iron, zinc and copper. Results: The study population consisted of 38 HIV-infected women receiving ART and 36 HIV-uninfected women who gave birth to premature infants. Protein (1.95 vs. 1.78 g/100g; p=0.04), fat (4.42 vs. 3.49 g/100g; p=0.01) and copper (0.64 vs. 0.56 mg/l; p=0.02) in breastmilk samples were higher while carbohydrate (5.37 vs. 6.67 g/100g; p=0.002) and zinc (5.26 vs. 5.78 mg/l; p=0.04) were lower in HIV-infected women compared to HIV-uninfected women. Zinc levels were significantly lower in HIV-infected women with early gestation infants, with lowest levels in women who received ≤4 weeks ART (0.58mg/l; p=0.03). Total energy (78.22 vs. 61.48 kCal/100ml) and fat (5.39 vs. 3.00g/100ml) levels were significantly higher in late gestational HIV-infected women who received <4 weeks ART. Copper levels (0.61mg/l) were higher in late gestation women who received 4-20 weeks ART exposure (p=0.05). The variances in nutritive values in these milk samples did not, however, range outside the normal values of premature breastmilk composition. The mean maternal BMI was 26.7kg/m2 and MUAC was 289mm. Maternal undernutrition (9%) and obesity prevalence (9%) was low. There was a high prevalence of IUGR (54%). Neither maternal nutritional status (p=0.79) nor HIV-status and ART regimen (p=0.72) were associated with IUGR. Similarly, the nature of IUGR (symmetrical vs asymmetrical) was not associated with maternal HIV-status (p=1.00). Head circumference restriction was less prevalent in infants born to women with ART exposure >20 weeks (p=0.003). Conclusion: HIV-infected women on ART can safely breastfeed their premature infants. Maternal nutritional status, HIV-status and ART regime did not influence neonatal nutritional status among premature infants in this study. Maternal ART over a longer period may protect the baby against IUGR, with specific reference to head circumference.