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
Open accessAbstract
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.
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Interventions for AUD have been reported in various general health care settings in sub-Saharan Africa, including HIV or sexually transmitted disease services, antenatal and postnatal care, tuberculosis care, and inpatient and outpatient care.
“In SSA, interventions for AUD have been reported in various general health care settings (3, 17–27), including services for people with HIV or other sexually transmitted diseases (9, 10, 13–16, 18, 21), antenatal and postnatal care (19, 27–29), care for people with tuberculosis (30, 31), inpatient and outpatient care (20, 26, 32–35).”
From Integration of Alcohol Use Disorder Interventions in General Health Care Settings in Sub-Saharan Africa: A Scoping Review (2022) · cites this paper as [19]
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- Authors
- Sania, A., Brittain, K., Phillips, T. K., Zerbe, A., Ronan, A., Myer, L., & Abrams, E. J.
- Affiliations
- ICAP Global Health (US)
- University of Cape Town (ZA)
- Corresponding author
- Sania, Ayesha
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2017-03
- Volume
- 7
- Issue
- 3
- Pages
- e014293
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5372146
- OpenAlex
- W2598141140
- Cited by
- 18
- References
- 51
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 1 · 2020: 2 · 2019: 2 · 2017: 1
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Elizabeth Glaser Pediatric AIDS Foundation
- U.S. President’s Emergency Plan for AIDS Relief (1R01HD074558)
- National Institutes of Health
- National Institute of Allergy and Infectious Diseases (T32AI114398)
- National Institute of Child Health and Human Development
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD074558)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- alcohol consumption, psychosocial stressors, preterm birth, small-for-gestational-age birth, women living with HIV, antenatal depression, psychological distress, intimate partner violence, periconception period, birth outcomes, antiretroviral therapy, maternal alcohol use, South Africa
- MeSH terms
- Adult, Alcohol Drinking, Female, Humans, Infant, Small for Gestational Age, Pregnancy, Pregnancy Complications, Prospective Studies, Risk Factors, South Africa, Stress, Psychological, Cohort Studies, HIV Infections, Comorbidity, Causality, Prevalence, Premature Birth
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