Effect of maternal postpartum diet on growth outcomes in dolutegravir-exposed, HIV-uninfected infants in Uganda.

Abstract

Background Early postnatal growth and body composition are critical indicators of infant health and predictors of long-term developmental and metabolic outcomes. In Uganda, the population of HIV-exposed uninfected (HEU) infants continues to increase due to the successful scale-up of prevention of mother-to-child transmission programs and widespread adoption of dolutegravir (DTG)-based antiretroviral therapy (ART). Although HEU infants remain HIV-negative, evidence suggests potential vulnerabilities in growth and body composition. Maternal postpartum diet may further influence these outcomes through its effect on breast milk composition, yet data from DTG- exposed populations in resource-limited settings remain limited. This study evaluated the effect of maternal postpartum dietary intake on early growth and body composition among exclusively breastfed DTG-exposed HEU infants in Uganda. Methodology A prospective longitudinal cohort study was conducted at the Makerere University–Johns Hopkins University Clinical Research Site in Kampala. Ninety-five mother–infant dyads (48 HEU and 47 HIV-unexposed uninfected [HUU]) were followed from birth to 10 weeks postpartum. Maternal dietary intake was assessed using interviewer-administered multiple-pass 24-hour dietary recalls. Infant growth was evaluated using standardized anthropometric measurements, while body composition outcomes, including fat mass and fat-free mass, were assessed using dual-energy X- ray absorptiometry (DEXA) at weeks 8 and 10. Early postnatal growth velocity from birth to 8 weeks was computed. Descriptive statistics, correlation analyses, and multivariable regression models were used to examine associations between maternal dietary intake, infant growth indicators, growth velocity, and body composition outcomes. Results Maternal energy and macronutrient intakes did not differ significantly between HIV-positive mothers on DTG-based ART and HIV-negative mothers. Infant anthropometric and DEXA- derived body composition outcomes were also comparable between HEU and HUU infants during the first 10 weeks of life. Among HEU infants, anthropometric indicators, particularly infant weight, were significant predictors of lean mass and fat mass at week 8. Early postnatal growth xiii velocity was strongly associated with infant body composition outcomes. Maternal dietary intake showed generally weak or non-significant associations with infant growth and body composition; however, among HUU infants, higher maternal saturated fat intake was positively associated with infant weight-for-age and BMI-for-age z-scores. Conclusion In conclusion, within the context of exclusive breastfeeding and high adherence to DTG-based ART, maternal HIV status and DTG exposure were not associated with adverse early growth or body composition outcomes. Infant anthropometry and early postnatal growth velocity emerged as the primary determinants of early body composition. The study recommends strengthening maternal nutrition counseling and routine growth monitoring within PMTCT programs, ensuring sustained adherence to DTG-based ART, and integrating early-life body composition surveillance where feasible. Further longitudinal studies are recommended to assess longer-term growth and metabolic outcomes among HEU children.