Associations of maternal HIV infection, anaemia and placental insufficiency with neurodevelopment and anaemia in South African children: a cross-sectional study

Abstract

Objective: To determine associations between maternal anaemia and child neurodevelopment and anaemia among 18-month-old children exposed to maternal HIV infection and placental insufficiency. Design: A cross-sectional study was conducted. Placental insufficiency was detected by an abnormal umbilical artery resistance index (UmA-RI) on Doppler ultrasound during gestation. Setting: Kalafong Provincial Tertiary Hospital. Subjects: In total, 260 mother–child pairs grouped into HIV-unexposed-uninfected children (CHUU): n = 198 vs. HIV-exposed-uninfected children (CHEU): n = 62, and normal UmA-RI (N-RI): n = 225 vs. abnormal UmA-RI (AbN-RI): n = 35 were investigated. Also, CHUU/N-RI (control): n = 178 was compared with CHEU/AbN-RI (dual exposure): n = 15. Outcome measures: Haemoglobin concentrations were tested using the HemoCue® Hb 201+. Bayley-III assessed children’s cognitive, motor, and language development at the corrected age. Results: More than one-third of children across the groups were mildly anaemic. Some 25.7% of mothers in AbN-RI group were mildly anaemic, significantly more than the N-RI mothers (9.8%); p = 0.027. In the CHEU group, maternal haemoglobin concentrations were associated with child haemoglobin concentrations: β = 0.19, 95% confidence interval (CI) (0.02,0.36); p = 0.028. The AbN-RI group had significantly lower mean cognitive composite scores compared with the N-RI group: 96.4 ± 12.2 vs. 100.0 ± 10.5; p = 0.017. Significantly lower mean cognitive scores were observed in CHEU/AbN-RI compared with CHUU/N-RI: 93.9 ± 12.9 vs. 100.0 ± 10.6; p < 0.001. There was no evidence to suggest an association between haemoglobin concentration and child neurodevelopment; however, in CHEU, cognitive development was associated with LAZ: β = 3.34, 95% CI (1.13,5.54), p = 0.004. Conclusions: Child health and nutrition-sensitive programmes need to prioritize CHEU and children with placental insufficiency as at-risk groups for cognitive delays.