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. 2017 Mar 20;7(3):e014293.
doi: 10.1136/bmjopen-2016-014293.

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

Ayesha Sania  1   2 , Kirsty Brittain  3   4 , Tamsin K Phillips  3   4 , Allison Zerbe  1 , Agnes Ronan  3   4 , Landon Myer  3   4 , Elaine J Abrams  1   5
Affiliations

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

Ayesha Sania et al. BMJ Open. .

Abstract

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.

Keywords: SGA; alcohol; birth weight; depression; preterm; stress.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Hypothesised direct and indirect pathways of effects of maternal mental health stressors on birth outcomes. (Figure drawn based on mechanisms described by Diego et al, Wadhwa et al, Neggers et al and Zuckerman et al16). ART, antiretroviral treatment; IPV, intimate partner violence; SGA, small for gestational age.
Figure 2
Figure 2
Distribution of preterm and SGA in low birthweight and normal birthweight infants. AGA, appropriate for gestational age; SGA, small for gestational age.
Figure 3
Figure 3
Prevalence of psychosocial stressors and alcohol consumption in study population.
See this image and copyright information in PMC

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