Effect of alcohol consumption and psychosocial stressors on preterm and small-for-gestational-age births in HIV-infected women in South Africa: a cohort study
Objectives Psychosocial stressors such as depression and stress, intimate partner violence (IPV) and alcohol use have been linked to preterm and small-for-gestational-age (SGA) births in general populations. The prevalence of psychosocial stressors and alcohol abuse is high in many HIV-infected (HIV...
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| Format: | Article |
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BMJ Publishing Group
2017-03-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/7/3/e014293.full |
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| author | Landon Myer Ayesha Sania Elaine J Abrams Kirsty Brittain Tamsin K Phillips Allison Zerbe Agnes Ronan |
| author_facet | Landon Myer Ayesha Sania Elaine J Abrams Kirsty Brittain Tamsin K Phillips Allison Zerbe Agnes Ronan |
| author_sort | Landon Myer |
| collection | DOAJ |
| description | Objectives Psychosocial stressors such as depression and stress, intimate partner violence (IPV) and alcohol use have been linked to preterm and small-for-gestational-age (SGA) births in general populations. The prevalence of psychosocial stressors and alcohol abuse is high in many HIV-infected (HIV+) populations. Our objective was to evaluate the effects of psychosocial stressors and alcohol abuse on birth outcomes in HIV-infected women.Methods Antenatal depression and non-specific psychological distress, periconception IPV and alcohol consumption were measured during the second trimester among HIV+ women initiating antiretroviral treatment with efavirenz + emtricitibine + tenofovir in Cape Town, South Africa. Log binomial regression models were used to estimate the risk ratios (RR) and 95% CIs of the effects of psychosocial stressors and periconception alcohol consumption on birth outcomes: SGA (birth weight <10th centile for gestational age) and preterm (<37 weeks) births.Results Of the 571 mother–infant pairs, 26% of women reported hazardous alcohol consumption (Alcohol Use Disorders Identification Test-C score ≥3) periconception periods, 11% reported depressive symptoms, 7% reported non-specific psychological distress and 15% reported experiencing physical or psychological IPV. 14% of infants were born preterm and 12% were SGA. Infants born to women reporting hazardous drinking were twice (adjusted RR 2.00 (95% CI 1.13 to 3.54)) as likely to be SGA compared with women reporting low alcohol intake. Alcohol consumption did not have a significant effect on the incidence of preterm birth. Depressive symptoms, non-specific psychological distress, physical and psychological IPV did not increase the risk of SGA or preterm birth significantly.Conclusions The observed elevated risk of SGA births associated with periconception alcohol consumption underscores the urgent need to reduce alcohol consumption among women of childbearing age. Interventions targeting modifiable risk factors of adverse birth outcomes need to be integrated into HIV prevention and maternal child health programmes to improve the long-term health of HIV-exposed children.Trial registration number NCT01933477; Pre-results. |
| format | Article |
| id | doaj-art-50c577dc369a470db7eecc7eeda2d1f3 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2017-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-50c577dc369a470db7eecc7eeda2d1f32025-08-20T03:48:43ZengBMJ Publishing GroupBMJ Open2044-60552017-03-017310.1136/bmjopen-2016-014293Effect of alcohol consumption and psychosocial stressors on preterm and small-for-gestational-age births in HIV-infected women in South Africa: a cohort studyLandon Myer0Ayesha Sania1Elaine J Abrams2Kirsty Brittain3Tamsin K Phillips4Allison Zerbe5Agnes Ronan67 Division of Epidemiology and Biostatistics and Centre for Infectious Diseases Epidemiology and Research, University of Cape Town Faculty of Health Sciences, Observatory, South Africa2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USADepartment of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA1Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa3Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South AfricaMailman School of Public Health, ICAP at Columbia University, New York City, New York, USA2 Centre for Infectious Diseases Epidemiology and Research, University of Cape Town, Rondebosch, Western Cape, South AfricaObjectives Psychosocial stressors such as depression and stress, intimate partner violence (IPV) and alcohol use have been linked to preterm and small-for-gestational-age (SGA) births in general populations. The prevalence of psychosocial stressors and alcohol abuse is high in many HIV-infected (HIV+) populations. Our objective was to evaluate the effects of psychosocial stressors and alcohol abuse on birth outcomes in HIV-infected women.Methods Antenatal depression and non-specific psychological distress, periconception IPV and alcohol consumption were measured during the second trimester among HIV+ women initiating antiretroviral treatment with efavirenz + emtricitibine + tenofovir in Cape Town, South Africa. Log binomial regression models were used to estimate the risk ratios (RR) and 95% CIs of the effects of psychosocial stressors and periconception alcohol consumption on birth outcomes: SGA (birth weight <10th centile for gestational age) and preterm (<37 weeks) births.Results Of the 571 mother–infant pairs, 26% of women reported hazardous alcohol consumption (Alcohol Use Disorders Identification Test-C score ≥3) periconception periods, 11% reported depressive symptoms, 7% reported non-specific psychological distress and 15% reported experiencing physical or psychological IPV. 14% of infants were born preterm and 12% were SGA. Infants born to women reporting hazardous drinking were twice (adjusted RR 2.00 (95% CI 1.13 to 3.54)) as likely to be SGA compared with women reporting low alcohol intake. Alcohol consumption did not have a significant effect on the incidence of preterm birth. Depressive symptoms, non-specific psychological distress, physical and psychological IPV did not increase the risk of SGA or preterm birth significantly.Conclusions The observed elevated risk of SGA births associated with periconception alcohol consumption underscores the urgent need to reduce alcohol consumption among women of childbearing age. Interventions targeting modifiable risk factors of adverse birth outcomes need to be integrated into HIV prevention and maternal child health programmes to improve the long-term health of HIV-exposed children.Trial registration number NCT01933477; Pre-results.https://bmjopen.bmj.com/content/7/3/e014293.full |
| spellingShingle | Landon Myer Ayesha Sania Elaine J Abrams Kirsty Brittain Tamsin K Phillips Allison Zerbe Agnes Ronan Effect of alcohol consumption and psychosocial stressors on preterm and small-for-gestational-age births in HIV-infected women in South Africa: a cohort study BMJ Open |
| title | Effect of alcohol consumption and psychosocial stressors on preterm and small-for-gestational-age births in HIV-infected women in South Africa: a cohort study |
| title_full | Effect of alcohol consumption and psychosocial stressors on preterm and small-for-gestational-age births in HIV-infected women in South Africa: a cohort study |
| title_fullStr | Effect of alcohol consumption and psychosocial stressors on preterm and small-for-gestational-age births in HIV-infected women in South Africa: a cohort study |
| title_full_unstemmed | Effect of alcohol consumption and psychosocial stressors on preterm and small-for-gestational-age births in HIV-infected women in South Africa: a cohort study |
| title_short | Effect of alcohol consumption and psychosocial stressors on preterm and small-for-gestational-age births in HIV-infected women in South Africa: a cohort study |
| title_sort | effect of alcohol consumption and psychosocial stressors on preterm and small for gestational age births in hiv infected women in south africa a cohort study |
| url | https://bmjopen.bmj.com/content/7/3/e014293.full |
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