Rising maternal obesity and persistent suboptimal gestational weight gain among women living with HIV in Kenya: A retrospective cohort study 2008–2017

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology Pub Date : 2025-08-06 DOI:10.1016/j.annepidem.2025.08.001

Nazha M. Diwan , Betty Mbithe , John Kinuthia , Tony J. Cagle , Charles Kibaara , Andrew Nagy Adly , Michael H. Chung , Angela M. Bengtson

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引用次数: 0

Abstract

Purpose

To describe trends in pre-pregnancy BMI (ppBMI), gestational weight gain (GWG), and associations with birth outcomes among women living with HIV (WLWH) in Kenya.

Methods

WLWH who initiated antenatal care ≤ 14 weeks of gestation at the Coptic Hope Center in Nairobi and Maseno, Kenya between 2008 and 2017 were identified. PpBMI was defined using first-trimester BMI (Kg/m²); GWG was assessed using weekly GWG rate in the second-and-third trimesters per National Academy of Medicine (NAM) guidelines. Associations between GWG z-scores and birthweight, low/high birthweight, and emergency cesarean-section (c-section) were examined using mixed-effects models.

Results

We identified 1190 pregnancies, of which more than half had overweight (34.3 %) or obese (18.0 %) ppBMI, 45.1 % had normal ppBMI, and 2.6 % were underweight. From 2008–2017, obese ppBMI among WLWH doubled, while normal ppBMI decreased by 8.2 %. Suboptimal GWG rates, both above and below NAM-recommendations, were common across ppBMI categories. A one-unit increase in GWG z-score was associated with higher birthweight (+45.96, 95 % CI: 15.29–75.17) and increased risk of emergency c-section (aRR=1.35, 95 % CI: 1.03–1.82).

Conclusion

From 2008–2017, maternal obesity among WLWH in Kenya increased, while GWG rates remained suboptimal. Future studies should examine barriers and possible interventions to address rising ppBMI and promote healthy GWG among WLWH.

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在肯尼亚感染人类免疫缺陷病毒的妇女中，孕产妇肥胖上升和妊娠期体重持续次优增加：2008-2017年回顾性队列研究

目的：描述肯尼亚感染艾滋病毒（WLWH）的妇女孕前体重指数（ppBMI）、妊娠体重增加（GWG）的趋势以及与分娩结局的关系。方法：对2008年至2017年在肯尼亚内罗毕和马塞诺科普特希望中心（Coptic Hope Center）开展产前保健的妊娠≤14周的WLWH进行鉴定。PpBMI采用妊娠早期BMI （Kg/m2）定义；根据美国国家医学科学院（NAM）指南，使用妊娠中期和妊娠晚期的每周GWG率来评估GWG。使用混合效应模型检验GWG - z评分与出生体重、低/高出生体重和紧急剖宫产（c-section）之间的关系。结果：我们确定了1190名孕妇，其中超过一半的孕妇ppBMI超重（34.3%）或肥胖（18.0%），45.1%的孕妇ppBMI正常，2.6%的孕妇体重不足。从2008年到2017年，肥胖人群的ppBMI增加了一倍，而正常人群的ppBMI下降了8.2%。高于或低于nami推荐值的次优GWG率在ppBMI类别中都很常见。GWG - z评分每增加一个单位与出生体重增加（+45.96,95% CI: 15.29-75.17）和急诊剖腹产风险增加相关（aRR=1.35, 95% CI: 1.03-1.82）。结论：从2008年到2017年，肯尼亚产妇肥胖增加，而GWG率仍然不理想。未来的研究应检查障碍和可能的干预措施，以解决ppBMI上升和促进健康的GWG在WLWH。

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来源期刊

Annals of Epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.40

自引率

1.80%

发文量

207

审稿时长

59 days

期刊介绍： The journal emphasizes the application of epidemiologic methods to issues that affect the distribution and determinants of human illness in diverse contexts. Its primary focus is on chronic and acute conditions of diverse etiologies and of major importance to clinical medicine, public health, and health care delivery.