Growth, neurodevelopmental outcomes and micronutrient intake in 18-month-old children with exposure to maternal human immunodeficiency virus and placental insufficiency: The UmbiGodisa cross-sectional study

Abstract

Background and aim

Maternal human immunodeficiency virus (HIV) and intrauterine growth restriction (IUGR) are both associated with suboptimal childhood growth and neurodevelopment. This study assessed growth and neurodevelopmental outcomes and micronutrient intakes in children who are HIV-exposed-uninfected (CHEU), compared to HIV-unexposed-uninfected children (CHUU), stratified based on evidence of placental insufficiency.

Methods

Placental insufficiency, as proxy for IUGR, was identified using abnormal umbilical artery resistance indices (UmA-RI) on pregnancy Doppler ultrasound. At 18-months postpartum, 264 mother–child pairs were evaluated and categorized into four subgroups: CHUU with normal UmA-RI (control group), CHEU with normal UmA-RI (HIV exposure only), CHUU with abnormal UmA-RI (placental insufficiency only) and CHEU with abnormal UmA-RI (double-exposure). Dietary intake was assessed using a single 24-h dietary recall, and dietary intake of iron, zinc, and iodine was quantified by meal analysis on FoodFinder™ 3.0. Anthropometric data were collected and converted into z-scores. The Bayley Scales of Infant and Toddler Development (Bayley-III) assessed cognitive, language, and motor function. Statistical comparisons used t-test or Mann–Whitney U-tests; associations were analyzed with Spearman's correlation.

Results

Children with dual exposure (CHEU/AbN-RI) had significantly lower z-scores compared to the control group, including length-for-age z-score (−1.4 ± 1.4 vs 0.0 ± 1.3; p = 0.001), weight-for-age z-score (−0.6 ± 1.0 vs 0.0 ± 1.2; p = 0.024) and head circumference-for-age z-score (0.4 ± 0.7 vs 0.9 ± 1.2; p = 0.035). Mean cognitive scores were also lower in this group (93.9 ± 12.9 vs 100.1 ± 10.8; p = 0.042). Language composite scores were low across all groups. Higher zinc intake was positively associated with language scores (r = 0.10; p = 0.042) and weight-for-age z-scores were associated with motor outcomes (r = 0.10; p = 0.028). Among CHEU, better growth parameters were positively associated with cognitive and motor developmental domains.

Conclusion

Children exposed to both maternal HIV and placental insufficiency showed signs of suboptimal growth, particularly stunting, and delayed cognitive development, compared to unexposed controls. These findings highlight the need for early identification and targeted interventions for high-risk children within Child Health/Nutrition programmes.