High rates of obesity and excessive catch-up growth in children with perinatal HIV exposure in the United States

BACKGROUND: Preterm birth (PTB) and small-for-gestational age (SGA) often occur in infants born to women with HIV and may influence growth among children perinatally HIV- exposed but uninfected (CHEU). SETTING: U.S. cohort at 22 sites. METHODS: CHEU were enrolled at birth into the SMARTT Dynamic cohort of the Pediatric HIV/AIDS Cohort Study network and followed through age 17 years. We calculated Z scores for singleton CHEU through age 7 years for weight (WAZ), length or height (LAZ/HAZ), and weight-for-length/body mass index (WFL/BMI)]; excessive catch-up growth was defined as WAZ increase >0.67 SD from birth to age 2 years. Birth weight-for-gestational age (GA) was categorized as small- (SGA), appropriate- (AGA), and large-for-GA (LGA). Piecewise linear regression models with slope changes were used to assess growth trajectories by SGA and PTB. RESULTS: Among 2,765 CHEU born 2007-2022, 9.2% were SGA, 14.4% preterm, and 47% had excessive catch-up growth. Among term infants, those born SGA had the highest percent (65%) with excessive catch-up growth. Those born SGA had lower mean WAZ and WLZ/BMIZ than AGA through age 7 years. Infants with PTB had higher mean WAZ, LAZ/HAZ, and WLZ/BMIZ at birth than term infants, but were similar by age 7 years. CONCLUSIONS: A high proportion of CHEU had excessive catch-up growth and obesity at age 5 years. While SGA infants had persistently lower Z-scores than AGA, obesity rates at age 5 years were comparable. These findings represent a paradigm shift from undernutrition to overnutrition, particularly in countries where obesity prevalence is high.