Maternal Anthropometry, Body Composition, and Fat Distribution by HIV Status and Antiretroviral Therapy Class in South African Women

Pregnancy affects adiposity, which may be influenced by HIV infection or antiretroviral therapy (ART). The objective of this study was to examine adiposity measures in the perinatal period, by HIV status and ART class. A total of 214 women (113 women with HIV [WWH], 71 initiated ART postconception), enrolled between 24 and 28 weeks of gestation and followed until 6-12 months postpartum, were assessed for longitudinal weight and cross-sectional postpartum anthropometry. A subset of 65 (52 WWH, 42 initiated ART postconception) had cross-sectional adiposity (body composition and fat distribution) measured at 6-12 months postpartum using dual-energy X-ray absorption scan. Multivariable linear and modified Poisson regression, adjusted for maternal age, pre-pregnancy body mass index, socioeconomic status, and postpartum months, examined associations of HIV status and postconception ART (dolutegravir-based [DTG] vs. efavirenz-based [EFV]) with anthropometry and adiposity outcomes. At enrollment, the median age was 30 years (interquartile range, 26-34) and 82% were multiparous. Between pre-pregnancy and postpartum, women gained an average of 2.33 kg (0.90 kg WWH), 30% lost weight (35% WWH), and 48% gained weight (38% WWH). WWH gained weight slower during pregnancy (0.27 vs 0.38 kg/week, <i>p</i> = .03) and were less likely to gain weight postpartum (RR = 0.72 95% CI 0.55, 0.93; <i>p</i> = .01) compared with women without HIV. Postpartum, mean body mass index was 32 kg/m² (standard deviation = 7.33) and 58% (53% WWH) of women had obesity. HIV was not associated with cross-sectional measures of postpartum anthropometry and adiposity. Among WWH, compared with EFV-based ART, DTG-based ART was not associated with weight gain during pregnancy or anthropometry and adiposity postpartum. Despite high rates of postpartum weight gain and obesity, no significant differences were observed in anthropometry and adiposity measures by HIV status and postconception ART. Nonetheless, these findings underscore the need for interventions to support healthy weight gain in pregnancy and postpartum weight loss to minimize pregnancy-associated obesity.