Pregnancy, body weight and human immunodeficiency virus infection in African women: a prospective cohort study in Kigali (Rwanda), 1992-1994

Objective To study the relationship between human immunodeficiency virus (H IV) infection and body weight in African women during and after pregnancy. Methods A prospective cohort study was initiated at the Centre Hospitalier de Kigali in July 1992. Every woman seen at the antenatal clinic and with a gestational age of <28 weeks was offered HIV-1 antibody testing. Comparabl e numbers of HIV-infected (HIV+) and uninfected (HIV-) women were recruited . At inclusion, socio-demographic characteristics and self-reported pre-pre gnancy weight were recorded; height and weight were measured. Each woman en rolled had a monthly follow-up until 9 months after delivery, with a clinic al examination including weighing. Three anthropometric indices were used t o answer the study objectives: weight, body mass index (BMI), and pregnancy balance. Results As of April 1994, 101 HIV+ and 106 HIV- women were followed until 5 months after delivery. Weight and BMI during pregnancy were lower in HIVwomen than in HIV- women. After delivery, weight and BMI gains were signifi cantly lower in HIV+ women. Until 5 months after delivery, the mean weight variation was -2.2 kg (standard deviation [SD] = 5.9 kg) in HIV+ women and +0.2 kg (SD = 6.6 kg) in HIV-women (P = 0.007) in comparison to pre-pregnan cy weight. Comparisons of the slopes of the weight curves did not show stat istical differences throughout the pregnancy, but it did during the post-pa rtum period (P = 0.02). Conclusions Our study suggests that HIV infection could impair nutritional status in pregnant women, especially during the post-partum period. Family planning and maternal and child health services including HIV testing and c ounselling, should consider a nutritional assessment and intervention progr amme targeted to HIV+ pregnant women.