Growth, anaemia, neurodevelopmental outcomes, and micronutrient intake of children with in utero growth restriction due to placental insufficiency and modification by maternal HIV status

The study, named UmbiGodisa (Umbi referring to the umbilical cord and Godisa being an African word meaning ‘bring me up, let me grow and develop’), was a follow-up of a sub-set of infants at 18 months, recruited from the South African arm of the Umbiflow International study. The UmbiGodisa study also included participants from the Siyakhula study. The overall aim of the study was to understand how in utero growth restriction, resulting from placental insufficiency, in addition to in utero and early postnatal environments altered by maternal HIV infection and anaemia, influence the child's growth and neurodevelopment, as well as anaemia, at age 18 months.Specific aim: To assess and compare, at the age 18 months, the growth and neurodevelopmental outcomes of children who had IUGR due to placental insufficiency, as measured by an abnormal UmA-RI on UmbiflowTM Doppler screening during pregnancy and as modified by maternal HIV infection, together with the impact of anaemia, in the Tshwane District in the Gauteng Province of South Africa.An abnormal umbilical artery resistance index (UmA-RI) on pregnancy Doppler ultrasound was used to detect placental insufficiency as a proxy for IUGR. The cross-sectional study investigated 271 mother-child pairs at 18-months postnatal, grouped into four subgroups: CHUU with normal UmA-RI (CHUU/N-RI; control group), CHEU with normal UmA-RI (CHEU/N-RI; single exposure), CHUU with abnormal UmA-RI (CHUU/AbN-RI; single exposure) and CHEU with abnormal UmA-RI (CHEU/AbN-RI; double exposure). Pregnancy and birth information was available. World Health Organisation standard procedures were followed to collect anthropometric data and compute z-scores. International Guide for Monitoring Child Development (GMCD) was used for developmental screening, and the Bayley Scale of Infant and Toddler Development III (Bayley-III) was used to test for cognitive, language and motor development. Premature births were corrected for gestational age. Previously used questionnaires and quantified 24-hour dietary recall were used to collect sociodemographic variables and dietary intake. FoodFinder™ 3.0 was used for meal analysis, quantifying dietary intake of iron, zinc, and iodine. Both maternal and children's haemoglobin concentrations were tested using HemoCue® Hb 201+. Comparisons were performed using an independent t-test and Mann-Whitney U test. Spearman’s correlation and regression models were used to determine associations.

本研究命名为UmbiGodisa（其中Umbi指代脐带，Godisa为非洲语，意为‘抚养我，让我成长与发展’），系对Umbiflow国际研究南非分支的一部分婴儿群体在18个月大时的后续研究。UmbiGodisa研究亦纳入了Siyakhula研究的参与者。本研究的总体目标在于探究由于胎盘不足导致的宫内生长受限，以及由母亲HIV感染和贫血所改变的宫内及早期产后环境，如何影响儿童的生长和神经发育，以及18个月大的儿童贫血状况。具体目标：评估并比较18个月大时，因胎盘不足导致的宫内生长受限（通过孕期UmbiflowTM多普勒筛查中异常的脐动脉阻力指数（UmA-RI）衡量）的儿童的生长和神经发育结果，并考虑母亲HIV感染以及贫血的影响，在南非豪登省茨瓦内地区进行研究。利用孕期多普勒超声检查中异常的脐动脉阻力指数（UmA-RI）作为宫内生长受限的替代指标来检测胎盘不足。横断面研究调查了271对母婴配对，在产后18个月时分为四个亚组：CHUU组（正常UmA-RI；对照组）、CHEU组（正常UmA-RI；单一暴露）、CHUU组（异常UmA-RI；单一暴露）和CHEU组（异常UmA-RI；双重暴露）。收集了孕期和出生信息。遵循世界卫生组织标准程序收集人体测量数据并计算z分数。使用国际儿童发展监测指南（GMCD）进行发展筛查，并采用贝利婴儿和幼儿发展量表第三版（Bayley-III）进行认知、语言和运动发展的测试。对早产儿进行了孕周校正。使用先前使用的问卷和定量24小时饮食回顾收集社会人口统计学变量和饮食摄入。使用FoodFinder™ 3.0进行餐食分析，量化铁、锌和碘的饮食摄入。使用HemoCue® Hb 201+测试母亲和儿童的血红蛋白浓度。比较使用独立t检验和Mann-Whitney U检验进行。使用斯皮尔曼相关和回归模型确定关联。