RESUMEN
Objectives: We evaluated the effect of multivitamin supplementation on delivery complications that can arise from maternal-fetal disproportion. Methods: We used data from a double-blind, randomized controlled trial among 8286 HIVnegative pregnant women in Dar es Salaam, Tanzania. From August 2001 to July 2004, eligible women were randomly assigned to receive daily multivitamins or placebo between 12 and 27 gestational weeks. All women received prenatal iron and folic acid supplementation. Results: Women in the multivitamin group experienced a 50% higher risk of prolonged labor requiring cesarean section or forceps delivery compared to the women in the placebo group (relative risk 1.52, 95% CI: 1.12-2.07; p=0.007). There was also a non-significant increase in the incidence of vaginal tear (RR-1.11 95% CI 0.99-1.24, p=0.06 ) in the multivitamin group. We found no difference in the risks of need for newborn resuscitation, low APGAR score and signs of fetal distress among the infants born to women receiving multivitamin and placebo. Increases in birth weight and head circumference of the newborn mediated 63% (95% CI- 33- 85%; P <0.0001) of the effect of the multivitamins on prolonged labor. In addition, maternal short stature (height <150 cm) and obesity (BMI≥30) were independently associated with significantly increased risks of prolonged labor. Conclusions: Multivitamin supplementation increased the risk of prolonged labor among HIVnegative pregnant women in Dar es Salaam. However, this risk did not result in any increased adverse fetal outcome. Routine multivitamin supplementation is best integrated in programs that provide emergency obstetric care for women at high risk for prolonged labor.
RESUMEN
Background: For at-risk HIV-negative individuals, whether malarial morbidity increases the likelihood of HIV infection when exposed is unknown. Hence, we investigate the malaria-associated risk of postnatal HIV infection in 1804 breastfeeding infants of HIV-positive women from Dar es Salaam, Tanzania. Methods: Six-week-old HIV-negative infants were followed until breastfeeding cessation or postnatal HIV infection. HIV-1 status was determined by a DNA PCR test. Malarial morbidity was diagnosed by physicians using a combination of clinical symptoms and laboratory tests. For analytic purposes, malaria was distinguished by diagnostic specificity as: (1) clinical; (2) probable, where laboratory testing is requested for parasitemia; and (3) blood smear-confirmed. Hazard ratios (HR) and 95% confidence intervals (CI) for the risk of HIV infection were estimated from multivariate Cox regression models. Results: Mean follow-up duration was 6.2 months (standard deviation=2.4 months), during which 91 new HIV infections developed and clinical malaria was diagnosed in 594(32.3%) children, including 283 (15.5%) probable and 80(4.4%) confirmed malaria episodes. Infants ever diagnosed with clinical and probable malaria were at 73% (95%CI:1.11 - 2.69) and 100% (95%CI:1.17-3.42) higher risk of postnatal HIV infection, respectively. This risk increased by 39% (95%CI: 1.08-1.80) and 59% (95%CI: 1.00-2.32), respectively, per episode increment in clinical and probable malarial; however, confirmed malaria was not significantly associated with HIV incidence (HR=2.09; 95%CI: 0.74 - 5.91). Conclusion: We found positive associations between child malarial infection and postnatal HIV infection among breastfeeding HIV-negative children of HIV-positive women. These findings suggest that malaria prevention in such infants may decrease the risk of HIV mother-to-child-transmission. However, specific future studies using laboratory-confirmed malaria in HIV-negative but HIV at risk populations are needed to substantiate these findings.