Intrauterine growth restriction (IUGR) and birth outcomes in a cohort of HIV-infected pregnant women in Cape Town, South Africa

Background: Intrauterine growth restriction (IUGR) is a major contributory factor of perinatal morbidity and mortality. This suboptimal growth is associated with infants being small-for-gestational age. In addition to genetic and placental factors, maternal factors such as infection are also responsible for IUGR. Numerous studies have shown that HIV infection could increase the risk of IUGR. Given the consequences of IUGR, determining the incidence of IUGR in a high HIV prevalence setting is essential. Screening for foetal growth abnormalities is an essential component of antenatal care, with foetal ultrasound playing a key role. Improving antenatal detection of IUGR in resource limited settings could improve perinatal outcomes. Methods: This research is a secondary analysis of a large prospective observational study conducted among pregnant women, seeking antenatal care at the Gugulethu MOU in South Africa. Pregnancy dating and foetal size was determined by research ultrasound in women ≤24 weeks' gestation. Women from the overall cohort were included if they had a singleton pregnancy, at least one ultrasound and a recorded estimated foetal weight. A subset of HIV-infected women enrolled in a longitudinal component were included for additional analyses. Growth restriction was determined using INTERGROWTH-21ST Project Standards. The incidence of IUGR was compared by HIV status in the overall cohort; while the relationship between estimated foetal weight and birthweight and size for gestational age was explored through regression modelling. Results: 1391 women were included in the overall cohort, and had an ultrasound at a median gestational age of 19 (16-23). The incidence of IUGR was very low (1.3%); with an unexpected difference observed by HIV status. In the nested cohort (n=453), using the ultrasound conducted at median gestational age of 28 weeks (27-28), an association between estimated foetal weight and birthweight was observed (β = 1.16, p <0.01). However, no association observed between estimated foetal weight and size for gestational age. Conclusions: While an unexpected difference was detected in IUGR by HIV status, further research is needed, into the incidence of IUGR in populations with HIV, taking into consideration ART status. Further exploration of the ability of foetal biometry to independently and accurately identify IUGR cases antenatally in resource limited settings is essential.

Grantor

Department of Public Health and Family Medicine

Year dc:date.issued

2023

Author dc:creator

• Sankar, Chenoa

Advisor dc:contributor.advisor

• Malaba, Thokozile

• Public Health

Handle dc:identifier.uri

http://hdl.handle.net/11427/38156

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/38156