Maternal HIV infection, drug use, and growth of uninfected children in their first 3 years

Abstract

Objective-To determine the separate effects of maternal HIV infection and drug use during pregnancy on growth of uninfected children in their first 3 years. Design-Retrospective analysis of measurements from health visitor records made during routine child health surveillance at 6 weeks, 10 months, and 3 years of age. Multilevel analysis allowed for between-infant variation in fitted growth lines, and adjustment for other factors. Growth was described in terms of an intercept (z score at term) and growth slopes (change in z score per year) up to, and from, 4 months. Subjects-290 case babies delivered in Edinburgh hospitals to women who reported injection drug use by either themselves or their HIV infected partner, and 186 community controls. A total of 131 (45%) of the case babies were born to women who used drugs, predominantly opiates, during pregnancy and 93 (32%) to HIV infected women. The eight infected children were excluded from analysis. Main outcome measures-Age and sex standardised z scores for height, weight, and body mass index. Results-459 (96%) of the 476 records for cases and controls were traced, yielding 1432 weight and 939 height measurements. Maternal HIV infection was not found to affect growth; at 3 years the estimated effect on weight z score was 0·16 with 95%/o confidence interval (-0·25 to 0·57) and for height 0·18 (-0·19 to 0·55). Drug use during pregnancy was associated with lighter babies at 40 weeks followed by depressed growth in the first four months, these infants remaining just slightly smaller at 3 years with an estimated effect on z scores of -0·5 for weight with 95%/o confidence interval (-0·89 to -0·11) and -0·37 (-0·72 to -0·02) for height. Conclusions-Maternal HIV infection does not adversely affect growth in uninfected infants, and the effect of drug use during pregnancy is limited to small decrease in size at 3 years.