Mid-thigh circumference as an indicator of nutritional status to predict adverse pregnancy outcomes among HIV-infected and HIV-uninfected women in Malawi

• Published in: BMC pregnancy and childbirth Vol. 21; no. 1; pp. 646 - 9
• Main Authors: Hirudayakanth, Keerthana, Gadama, Luis, Dadabhai, Sufia, Katumbi, Chaplain, Mvula, Hazzie, Makanani, Bonus, Taulo, Frank, Taha, Taha E
• Format: Journal Article
• Language: English
• Published: England BioMed Central 23-09-2021; BMC
• Subjects: Adult; Antiretroviral drugs; Birth weight; Body mass index; Body measurements; Body Size - physiology; Chronic obstructive pulmonary disease; Female; Gestational Age; Health facilities; HIV; HIV infection; HIV Infections; Human immunodeficiency virus; Humans; Infant, Low Birth Weight; Infant, Newborn; Informed consent; Malawi; Malawi - epidemiology; Maternal anthropometry; Menstruation; Mid-thigh circumference; Mortality; Multiple births; Nutrition; Nutritional status; Nutritional Status - physiology; Pregnancy; Pregnancy Complications - epidemiology; Pregnancy Outcome - epidemiology; Pregnancy outcomes; Premature birth; Premature Birth - epidemiology; Prospective Studies; Questionnaires; Risk factors; Sociodemographics; Socioeconomic factors; Thigh - physiology; Womens health; Young Adult; Malawi; Tanzania; Mid-thigh circumference; Body-mass index; Malawi; Pregnancy outcomes; HIV infection; Maternal anthropometry
• ISSN: 1471-2393; 1471-2393
• DOI: 10.1186/s12884-021-04118-4

High rates of adverse pregnancy outcomes globally raise the need to understand risk factors and develop preventative interventions. The Pregnancy Outcomes in the Era of Universal Antiretroviral Treatment in Sub-Saharan Africa (POISE Study) was a prospective, observational cohort study conducted from 2016 to 2017 in Blantyre, Malawi. We examine the associations between indicators of nutritional status, specifically mid-thigh circumference (MTC) and body-mass index (BMI), and adverse pregnancy outcomes, low birth weight (LBW), preterm birth (PTB), and small-for-gestational age (SGA), in a cohort of HIV-infected and HIV-uninfected women.
Sociodemographic, clinical, laboratory, and maternal height, weight and MTC data were collected immediately before or after delivery at the Queen Elizabeth Central Hospital (QEHC) and 4 affiliated health centers in Blantyre, Malawi. LBW was defined as birth weight < 2.5 kg; PTB as gestational age < 37 weeks using Ballard score; and SGA as birth weight < 10th percentile for gestational age. Descriptive, stratified, and multivariable logistic regression were conducted using R.
Data from 1298 women were analyzed: 614 HIV-infected and 684 HIV-uninfected. MTC was inversely associated with LBW (adjusted odds ratio [aOR] = 0.95, p = 0.03) and PTB (aOR 0.92, p < 0.001), after controlling for HIV status, age, socioeconomic status and hemoglobin. The association between MTC and SGA was (aOR 0.99, p = 0.53). Similarly, higher BMI was significantly associated with lower odds of PTB (aOR 0.90, p < 0.001), LBW (aOR 0.93, p = 0.05), and SGA (aOR 0.95, p = 0.04).
We observed an inverse relationship between MTC and adverse pregnancy outcomes in Malawi irrespective of HIV infection. MTC performs comparably to BMI; the ease of measuring MTC could make it a practical tool in resource-constrained settings for identification of women at risk of adverse pregnancy outcomes.