Perinatal human immunodeficiency virus-1 transmission and intrauterine growth: a cohort study in Butare, Rwanda.

OBJECTIVE: To study the association of perinatal human immunodeficiency virus (HIV)-1 transmission with birth outcomes, including birth weight, gestational age, ponderal index, head circumference, and weight/head ratio. METHODS: Data from a prospective cohort study of 627 pregnant women and their infants in Butare, Rwanda, from October 1989 until April 1994 were analyzed. A total of 318 HIV-1-infected and 309 seronegative women were enrolled during pregnancy and gave birth to 590 live singletons. Multiple linear regression modeling was used to assess the association of mother-child HIV status with several birth outcome measures. RESULTS: Unadjusted mean birth weight of HIV- infected infants was 235 g (95% confidence interval [CI] = 94 to 376 g) less than that of HIV-uninfected infants born to HIV-positive mothers (the reference group). After adjustment for gestational age, socioeconomic factors, maternal age, parity, hematocrit, and anthropomorphic measures, mean birth weight of HIV-infected infants was 154 g (95% CI = 38 to 271 g) lower than that of the reference group. When infants born to HIV-seronegative mothers were compared with the reference group, mean birth weights did not differ. Adjusted models resulted in estimates of mean head circumference 0.6 cm smaller (95% CI = 0.2 to 1.1 cm), ponderal index 0.14 lower (95% CI = 0.05 to 0.23), weight/head ratio 3.5 lower (95% CI = 0.5 to 6.4), and gestational age 0.5 weeks shorter (95% CI = 0.1 to 0.9 weeks) for HIV-infected infants than for the reference group. CONCLUSIONS: After adjustment for potential confounding variables, this study showed statistically significant differences in birth weight, gestational age, ponderal index, and weight/head ratio when HIV-infected infants were compared with noninfected infants born to HIV-positive mothers. HIV-1, mother-to-child transmission, Africa, intrauterine growth, birth weight, gestational age, ponderal index.

Maternal human immunodeficiency virus 1 infection and intrauterine growth: a prospective cohort study in Butare, Rwanda.

A prospective cohort study of 318 human immunodeficiency virus 1 (HIV-1)-infected and 309 seronegative pregnant women was carried out in Butare, Rwanda. Birth weight was significantly lower among singleton infants born alive to HIV-1-infected mothers compared with those born alive to seronegative mothers (2706 g vs. 2825 g; P = 0.002). Crown-to-heel length, head circumference, chest circumference and placental weight were also reduced. Maternal HIV-1 infection was significantly associated with intrauterine growth retardation but not with preterm birth. Differences in the body mass index and weight/head ratio suggest that the adverse impact on live born infants may have been most severe towards the end of pregnancy, resulting in a lean infant with a relatively large head. The higher frequency of intrauterine growth retardation could not be explained by potential confounding factors such as maternal cigarette smoking, history of sexually transmitted diseases or sociodemographic characteristics. The neonatal physical examination did not reveal any differences in clinical signs or symptoms within 48 hours of birth except for the presence of conjunctivitis which was more common among infants of HIV-1-infected mothers. The perinatal and neonatal mortality rates were not significantly affected by maternal HIV-1 status.

[The influence of amenorrhea on the behavior of Rwandan women]. / Influence de l'amenorrhee sur le comportement de la femme Rwandaise.

PIP: Amenorrhea gravely affects the psychic life and profoundly changes the behavior of Rwandan women. Women with primary amenorrhea (failure to menstruate at puberty) who have well-developed secondary sexual characteristics go to traditional healers who have sexual intercourse with them, spreading sexually transmitted diseases, to open the way for the menstrual flow. Women with primary amenorrhea and no breasts (dwarfism and infantilism) are sad, cannot have children, and are considered inferior by society. According to Rwandan beliefs, menstrual bleeding of unmarried women with secondary amenorrhea (absence of menstruation after it has once been established) empties itself into an obscure cavity, causing lumbar pain, nervous tension, and headaches. Rwandan women explain postpartum or lactational amenorrhea as a latent pregnancy causing a psychological shock which mimics a miscarriage. Living together for three months without a pregnancy causes the menstrual cycle to lengthen alternating with regular excessive bleeding (a miscarriage threat). This constitutes amenorrhea of infertile women, according to Rwandan beliefs. Menopausal women live in an illusion of pregnancy. After two years of pregnancy, the menopausal woman worries about the delivery of her fetus transformed into rock and expresses her concerns at a gynecologic visit. She worries about her long and painful tragic death which follows the death of the fetus. All these different types of amenorrhea have two types of effect on Rwandan women's behavior: happy effects and troubling effects. Management of these amenorrheas must be preoccupied with the etiologic problem and the problem of latent pregnancy. The most frequent complaints associated with latent pregnancy are genital bleeding, past-due delivery, reduction of the frequency and amplitude of fetal movements, reduction of the volume of the abdomen, and prolonged labor.^ieng