PERINATAL HUMAN IMMUNODEFICIENCY VIRUS-1 TRANSMISSION AND INTRAUTERINE GROWTH - A COHORT STUDY IN BUTARE, RWANDA

Objective. To study the association of perinatal human immunodeficienc y virus (HIV)-1 transmission with birth outcomes, including birth weig ht, gestational age, ponderal index, head circumference, and weight/he ad ratio. Methods. Data from a prospective cohort study of 627 pregnan t women and their infants in Butare, Rwanda, from October 1989 until A pril 1994 were analyzed. A total of 318 HIV-l-infected and 309 seroneg ative women were enrolled during pregnancy and gave birth to 590 live singletons. Multiple linear regression modeling was used to assess the association of mother-child HIV status with several birth outcome mea sures. Results. Unadjusted mean birth weight of HIV-infected infants w as 235 g (95% confidence interval [CI] = 94 to 376 g) less than that o f HIV-uninfected infants born to HIV-positive mothers (the reference g roup). After adjustment for gestational age, socioeconomic factors, ma ternal age, parity, hematocrit, and anthropomorphic measures, mean bir th weight of HIV-infected infants was 154 g (95% CI = 38 to 271 g) low er than that of the reference group. When infants born to HIV-seronega tive mothers were compared with the reference group, mean birth weight s did not differ. Adjusted models resulted in estimates of mean head c ircumference 0.6 cm smaller (95% CI = 0.2 to 1.1 cm), ponderal index 0 .14 lower (95% CI = 0.05 to 0.23), weight/head ratio 3.5 lower (95% CI 0.5 to 6.4), and gestational age 0.5 weeks shorter (95% CI = 0.1 to 0 .9 weeks) for HIV-infected, infants than for the reference group. Conc lusions. After adjustment for potential confounding variables, this st udy showed statistically significant differences in birth weight, gest ational age, ponderal index, and weight/head ratio when HIV-infected i nfants were compared with noninfected infants born to HIV-positive mot hers.