Anemia in Pregnancy among Women Living with HIV and Neurodevelopmental Outcomes of their HIV-exposed Uninfected Infants

Abstract

Prenatal anemia is associated with adverse maternal and infant outcomes. Children HIV-exposed uninfected (cHEU) experience poorer outcomes than HIV-unexposed uninfected peers (cHUU), despite maternal antiretroviral therapy (ART). We aimed to compare pregnancy hemoglobin concentration and the prevalence of anemia among women living with HIV (WLWH) and women without HIV and identify associations between anemia during pregnancy with neurodevelopmental outcomes of offspring at 36 months of age. We utilized a Kenyan birth cohort enrolling pregnant WLWH and without HIV and followed them and their children to 36-months postpartum. Pregnancy hemoglobin was abstracted from medical records, and 36-month neurodevelopment was assessed using Bayley Scales of Infant and Toddler Development-4. Linear and Poisson regressions evaluated associations between maternal HIV and pregnancy hemoglobin or anemia, adjusting for age, parity, dietary diversity, mid-upper arm circumference, education, and iron supplementation. Bayley scores were converted to z-scores. Linear regression estimated associations of cognition, language, and motor z-scores with prenatal hemoglobin and HIV, adjusting for maternal education, prematurity, and sex. Among 157 WLWH and 171 women without HIV, WLWH had lower pregnancy hemoglobin (adjusted beta=-0.73; 95% CI -1.13, -0.32) and higher prevalence of anemia (adjusted prevalence ratio 1.74; 95% CI 1.21, 2.50) than women without HIV. We found no significant associations between Bayley domain scores and HIV exposure or prenatal hemoglobin or anemia. In conclusion, WLWH had lower pregnancy hemoglobin and higher anemia prevalence than women without HIV. Targeted strategies to improve hemoglobin status of WLWH during pregnancy are needed.