Newly Diagnosed HIV is Associated with Lower Rates Of Gestational Weight Gain and Loss of Mid‐Upper Arm Circumference among Pregnant Kenyan Women
Authors: Widen Elizabeth M. , Collins Shalean , Wekesa Pauline , Krumdieck Natalie , Onono Maricianah , Young Sera L 
Published: November 2023

Nutrition, HIV‐infection and food insecurity are likely linked in a complex multi‐directional relationship, which may be exacerbated during periods of increased nutritional need such as pregnancy. However, little is known about how these factors impact pregnancy weight gain and body composition, and few studies have evaluated the role of food insecurity in these changes. Thus, we evaluated the role of maternal HIV infection and food insecurity in body composition changes during pregnancy in Kenyan women.

Pregnant women (n=371) were enrolled at 7 clinics in Nyanza province in western Kenya using purposive sampling by HIV status (newly diagnosed as HIV‐infected during this pregnancy, previously diagnosed HIV‐infected, or HIV‐uninfected) and individual food insecurity [low, medium, high, (Natamba et al., 2014)]. Measurements at enrollment (25.4±2.7 wks gestation) and follow up (33.5±1.8 wks) included: height, weight, mid‐upper arm circumference (MUAC), fat (FM) and fat free mass (FFM) by bioimpedance analysis, and triceps skinfold thickness (TSF). Arm‐muscle area (AMA) and arm‐fat area (AFA) were calculated from MUAC and TSF. Individual food insecurity, appetite and dietary diversity were assessed. Multivariate linear regression was used to relate HIV to body composition changes, adjusting for covariates (hunger season, gravidity, age, height, dietary diversity, household assets, gestational age, weeks of follow up between visits, food insecurity and appetite). A subsample (n=225) with singleton gestations, enrolled ≥20 weeks gestation and with follow‐up ≥3.5 weeks after enrollment were included in this analysis.

In multivariate models, compared to HIV‐uninfected women, women with newly‐diagnosed HIV showed lower rates of gestational weight gain (GWG, β −0.15 kg/wk, p=0.03), a decrease in MUAC (Δ β −0.66 cm, p=0.02), and a trend towards greater loss of FFM during follow up (β − 0.93 kg, p=0.06); but not FM, AMA or AFA. Women previously diagnosed with HIV did not differ from HIV‐uninfected women in GWG, MUAC, FM, AMA, or AFA. In all models, food insecurity was not associated with body composition change. Dietary diversity was positively associated with GWG (β 0.07 kg/wk, p<0.001) and MUAC (β 0.20 cm, p<0.001); but not other outcomes.

In conclusion, a new HIV diagnosis was associated with lower rates of GWG and loss of MUAC during pregnancy. Therefore, recent diagnosis may be a useful indicator for compromised nutritional status and for targeting nutrition interventions. Strikingly, food insecurity was not associated with maternal body composition changes, suggesting maternal nutrient stores were protected with increasing food insecurity; but it is unknown whether fetal growth or nutrient status was compromised. Follow‐up research could examine mechanisms underpinning this association, such as antiretroviral regimen.

Support or Funding Information

Widen T32DK007559, SLY K01 MH098902