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 Umbiflow^TM 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.