Maternal phenotype, infant size and breast milk composition in women living with HIV

Abstract

The impact of maternal factors on the size of HIV‐exposed‐uninfected (HEU) infants and breast milk composition is poorly understood. Anthropometry, bio‐electrical impedance, haemoglobin and HIV viral load data of women living with HIV (WLWH) and without HIV (WLWOH) were compared and related to their infants' anthropometric Z‐scores and breast milk macronutrients 6 weeks and 6 months postnatally. At both time points, WLWH (6‐week: n = 83; 6‐month: n = 63) had lower reactance (measure of body cell mass) (6‐week: p = 0.016; 6‐month: p < 0.001), phase angle (PhA) (measure of cell health) (6‐week: p = 0.001; 6‐month: p = 0.002) and haemoglobin (6‐week: p = 0.002; 6‐month: p = 0.004) than WLWOH (6‐week: n = 90; 6‐month: n = 73). HEU infants had lower weight‐for‐age Z‐scores (WAZ) (6‐week: p = 0.010; 6‐month: p = 0.005). Breast milk composition did not differ between groups. At 6 weeks, HEU infants had lower head circumference‐for‐age Z‐scores (HCAZ) (p = 0.014). Bivariate regression demonstrated maternal HIV predicted lower infant WAZ (ß = −0.442; p = 0.011) and HCAZ (ß = −0.445; p = 0.014). Maternal body mass index (BMI) and mid‐upper arm circumference were positively associated with breast milk protein content (ß = 0.018; p = 0.014 and ß = 0.025; p = 0.002, respectively). At 6 months (bivariate regression) maternal HIV predicted lower infant WAZ (ß = −0.609; p = 0.005) and length‐for‐age Z‐scores (ß = −0.741; p = 0.018). Higher maternal BMI and PhA were associated with higher infant WAZ (ß = 0.622; p = 0.015 and ß = 0.055; p = 0.017, respectively). On multivariable analysis, maternal HIV remained a predictor of lower WAZ (ß = −0.568; p = 0.024). In conclusion, maternal HIV infection and phenotype predict the size of infants and breast milk composition up to 6 months postnatally.