Breastmilk composition of HIV-infected mothers receiving antiretroviral therapy who gave birth to premature infants
Date
2016-03
Authors
Journal Title
Journal ISSN
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Publisher
Stellenbosch : Stellenbosch University
Abstract
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.
AFRIKAANSE OPSOMMING : Agtergrond: Die voorkoms van premature geboortes is aan die toeneem in Suider Afrika. Daar is ‘n beduidende verwantskap tussen premature geboorte en menslike immuniteitsgebreksvirus (MIV)-infeksie tydens swangerskap. Moeders met MIV of moeders wat chronies wangevoed is of vetsugtig is, is meer geneig om geboorte aan ’n premature baba met intra-uteriene groeivertraging (IUGV) te skenk. Twee belangrike strategieë om MIV-oordrag van moeder na kind te voorkom asook om morbiditeit en mortaliteit te verlaag is om premature babas met borsmelk te voed en terselfdertyd die moeder en baba van antiretrovirale terapie (ART) te voorsien. Onlangse literatuur rapporteer dat daar verskille in die borsmelksamestelling van MIV-geїnfekteerde en MIV-ongeїnfekteerde moeders is. Die uitwerking van MIV en ART op die borsmelksamestelling van die moeders van premature babas is egter tans onbekend. Studiedoelwitte: Die primêre doel van die studie was om die borsmelksamestelling van moeders wat met MIV-geїnfekteer is en dié van moeders wat nie met MIV-geїnfekteer is nie, te bepaal en te vergelyk. Die sekondêre doelwitte was om die voedingstatus van MIV-geїnfekteerde en MIV-ongeїnfekteerde moeders te bepaal en te vergelyk, sowel as om die neonatale voedingstatus van premature babas te bepaal en in verhouding met maternale voedingstatus, MIV-status en ART-regime te evalueer. Deelnemers en Metodes: Die studie-ontwerp was ’n beskrywende deursnit-studie met ’n analitiese komponent. Deelnemers het MIV-geїnfekteerde en MIV-ongeїnfekteerde moeders wat geboorte aan ʼn premature baba geskenk het, ingesluit. Moeders is verder in vier groepe volgens MIV-status, gestasietydperk en ART-tydperk verdeel. Moeders het demografiese inligting asook twee borsmelkmonsters op dag sewe en nege van laktasie verskaf. Maternale antropometrie (gewig, lengte en midarmomtrek) is op dag sewe postpartum geneem. Neonatale antropometrie (gewig, lengte en kopomtrek) is met geboorte geneem en lengte en kopomtrek is op dag sewe postpartum weer geneem. Die borsmelkmonsters is vir totale energie, proteїene, koolhidrate, vet, fosfaat, yster, sink en koper geanaliseer. Resultate: Die studiepopulasie het uit 38 MIV-geїnfekteerde moeders wat ART ontvang en 36 MIV-ongeїnfekteerde moeders met premature babas, bestaan. Die proteїene- (1.95 vs. 1.78 g/100g; p=0.04), vet- (4.42 vs. 3.49 g/100g; p=0.01) en koperinhoud (0.64 vs. 0.56 mg/l; p=0.02) in die borsmelkmonsters was verhoog en die koolhidraat- (5.37 vs. 6.67 g/100g; p=0.002) en sinkinhoud (5.26 vs. 5.78 mg/l; p=0.04) was verlaag onder MIV-geїnfekteerde moeders vergeleke met dié van MIV-ongeїnfekteerde moeders. Sinkvlakke was beduidend laer onder MIV-geїnfekteerde moeders, met die laagste vlakke onder vroeë-gestasie moeders met ART blootstelling <4 weke (0.58mg/l; p=0.03). Die totale energie- (78.22 vs. 61.48 kKal/100ml, p=0.03) en vetvlakke (5.39 vs. 3.00g/100ml, p=0.04) was beduidend hoër onder laat-gestasie MIV-geїnfekteerde moeders met <4 weke ART. Kopervlakke was hoër (0.8mg/100ml) onder die laat-gestasie MIV-geїnfekteerde moeders met 4-20 weke ART blootstelling (p=0.05). Die gemiddelde maternale LMI was 26.7 kg/m2 en die gemiddelde midarmomtrek was 289 mm. Die voorkoms van maternale ondervoeding (9%) en vetsugtigheid (9%) was laag. Daar was ’n hoë voorkoms van IUGV (54%). Maternale voedingstatus (p=0.79), MIV-status en ART-regime (p=0.82) was nie geassosieer met IUGV nie. Net so was die tipe IUGV (simmetries teenoor onsimmetries) nie geassosieer met maternale MIV-status nie (p=1.00). Kopomtrekvertraging was beduidend laer onder babas van moeders met >20 weke ART blootstelling (p=0.003). Gevolgtrekking: MIV-geїnfekteerde moeders kan veilig hul premature babas borsvoed. Maternale voedingstatus, MIV-status en ART regime het nie IUGV in premature babas in hierdie studie beïnvloed nie. ‘n Langer tydperk van ART blootstelling mag die baba teen kopomtrekvertraging beskerm.
AFRIKAANSE OPSOMMING : Agtergrond: Die voorkoms van premature geboortes is aan die toeneem in Suider Afrika. Daar is ‘n beduidende verwantskap tussen premature geboorte en menslike immuniteitsgebreksvirus (MIV)-infeksie tydens swangerskap. Moeders met MIV of moeders wat chronies wangevoed is of vetsugtig is, is meer geneig om geboorte aan ’n premature baba met intra-uteriene groeivertraging (IUGV) te skenk. Twee belangrike strategieë om MIV-oordrag van moeder na kind te voorkom asook om morbiditeit en mortaliteit te verlaag is om premature babas met borsmelk te voed en terselfdertyd die moeder en baba van antiretrovirale terapie (ART) te voorsien. Onlangse literatuur rapporteer dat daar verskille in die borsmelksamestelling van MIV-geїnfekteerde en MIV-ongeїnfekteerde moeders is. Die uitwerking van MIV en ART op die borsmelksamestelling van die moeders van premature babas is egter tans onbekend. Studiedoelwitte: Die primêre doel van die studie was om die borsmelksamestelling van moeders wat met MIV-geїnfekteer is en dié van moeders wat nie met MIV-geїnfekteer is nie, te bepaal en te vergelyk. Die sekondêre doelwitte was om die voedingstatus van MIV-geїnfekteerde en MIV-ongeїnfekteerde moeders te bepaal en te vergelyk, sowel as om die neonatale voedingstatus van premature babas te bepaal en in verhouding met maternale voedingstatus, MIV-status en ART-regime te evalueer. Deelnemers en Metodes: Die studie-ontwerp was ’n beskrywende deursnit-studie met ’n analitiese komponent. Deelnemers het MIV-geїnfekteerde en MIV-ongeїnfekteerde moeders wat geboorte aan ʼn premature baba geskenk het, ingesluit. Moeders is verder in vier groepe volgens MIV-status, gestasietydperk en ART-tydperk verdeel. Moeders het demografiese inligting asook twee borsmelkmonsters op dag sewe en nege van laktasie verskaf. Maternale antropometrie (gewig, lengte en midarmomtrek) is op dag sewe postpartum geneem. Neonatale antropometrie (gewig, lengte en kopomtrek) is met geboorte geneem en lengte en kopomtrek is op dag sewe postpartum weer geneem. Die borsmelkmonsters is vir totale energie, proteїene, koolhidrate, vet, fosfaat, yster, sink en koper geanaliseer. Resultate: Die studiepopulasie het uit 38 MIV-geїnfekteerde moeders wat ART ontvang en 36 MIV-ongeїnfekteerde moeders met premature babas, bestaan. Die proteїene- (1.95 vs. 1.78 g/100g; p=0.04), vet- (4.42 vs. 3.49 g/100g; p=0.01) en koperinhoud (0.64 vs. 0.56 mg/l; p=0.02) in die borsmelkmonsters was verhoog en die koolhidraat- (5.37 vs. 6.67 g/100g; p=0.002) en sinkinhoud (5.26 vs. 5.78 mg/l; p=0.04) was verlaag onder MIV-geїnfekteerde moeders vergeleke met dié van MIV-ongeїnfekteerde moeders. Sinkvlakke was beduidend laer onder MIV-geїnfekteerde moeders, met die laagste vlakke onder vroeë-gestasie moeders met ART blootstelling <4 weke (0.58mg/l; p=0.03). Die totale energie- (78.22 vs. 61.48 kKal/100ml, p=0.03) en vetvlakke (5.39 vs. 3.00g/100ml, p=0.04) was beduidend hoër onder laat-gestasie MIV-geїnfekteerde moeders met <4 weke ART. Kopervlakke was hoër (0.8mg/100ml) onder die laat-gestasie MIV-geїnfekteerde moeders met 4-20 weke ART blootstelling (p=0.05). Die gemiddelde maternale LMI was 26.7 kg/m2 en die gemiddelde midarmomtrek was 289 mm. Die voorkoms van maternale ondervoeding (9%) en vetsugtigheid (9%) was laag. Daar was ’n hoë voorkoms van IUGV (54%). Maternale voedingstatus (p=0.79), MIV-status en ART-regime (p=0.82) was nie geassosieer met IUGV nie. Net so was die tipe IUGV (simmetries teenoor onsimmetries) nie geassosieer met maternale MIV-status nie (p=1.00). Kopomtrekvertraging was beduidend laer onder babas van moeders met >20 weke ART blootstelling (p=0.003). Gevolgtrekking: MIV-geїnfekteerde moeders kan veilig hul premature babas borsvoed. Maternale voedingstatus, MIV-status en ART regime het nie IUGV in premature babas in hierdie studie beïnvloed nie. ‘n Langer tydperk van ART blootstelling mag die baba teen kopomtrekvertraging beskerm.
Description
Thesis (MNutr)--Stellenbosch University, 2016.
Keywords
Breast milk, Premature infants -- Nutrition, HIV-positive women, Highly active antiretroviral therapy, UCTD