Maternal HIV exposure and intrauterine growth restriction (IUGR) due to placental insufficiency both carry major risks to early child growth. We compared the growth outcomes of children aged 18 months who had abnormal umbilical artery resistance indices (UmA-RI), as a marker of placental insufficiency, with a comparator group of children with normal UmA-RI during pregnancy, as mediated by maternal HIV infection. The cross-sectional study included 271 children, grouped into four subgroups based on HIV exposure and history of normal/abnormal UmA-RI, using available pregnancy and birth information. Standard procedures were followed to collect anthropometric data, and z-scores computed as per World Health Organization growth standards. Lower length-for-age z-scores (LAZ) were observed in children who were HIV-exposed-uninfected (CHEU) (−0.71 ± 1.23; p = 0.004) and who had abnormal UmA-RI findings (−0.68 ± 1.53; p < 0.001). CHEU with abnormal UmA-RI had lower LAZ (−1.3 ± 1.3; p < 0.001) and weight-for-age z-scores (WAZ) (−0.64 ± 0.92; p = 0.014) compared to the control group. The prevalence of stunting was 40.0% in CHEU with abnormal UmA-RI and 16.0% in CHEU with normal UmA-RI (p < 0.001; p = 0.016, respectively). In conclusion, maternal HIV exposure and placental insufficiency are independent risk factors for childhood stunting, with this risk potentiated when these two risk factors overlap.

Background The increasing population of HIV-exposed-uninfected (HEU) infants are known to be at risk of poor nutritional status and suboptimal growth, with biological risk factors implicated, yet the cost to families of feeding infants is often overlooked. Objective The study compared the infant feeding practices and costs and macronutrient intake of HEU vs HIV-unexposed-uninfected (HUU) six-month-old infants in the Gauteng Province of South Africa. Methods A cross-sectional study investigated 46 HEU and 55 HUU infants aged six months and utilised a single quantified 24-hr recall and the FoodFinder™ program for meal analysis. The estimation of diet cost utilised supermarket food prices based on the 24-hr recall method. Results Mothers of HEU infants had significantly lower income (p<0.01) and educational attainment (p=0.03). The infant feeding practices differed between HEU vs HUU infants (p=0.05): exclusive breastfeeding (50.0% vs 34.0%) and mixed breastfeeding (38.1% vs 64.2%). Common complementary foods for HEU versus HUU infants included commercial infant cereals (CIC) (48.7% vs 70.9%; p=0.04); fruits and vegetables (33.3% vs 15.7%; p=0.05) and maize meal porridge (25.6% vs 15.7%; p=0.24), respectively. The mean daily cost of diet of HEU vs HUU infants was 8.55±7.35ZAR ($0.68±0.59USD) vs 10.97±7.92ZAR ($0.88±0.63 USD); (p=0.10). Regarding the complementary feeding, there were non-significant differences in protein, fat, and carbohydrate intakes (p>0.05) and their costs per daily intake (p>0.05) between the groups. Conclusion There are no significant differences in cost, feeding and macronutrient intakes between HEU and HUU. Suboptimal breastfeeding practices remains an issue within the first six months. More sustained effort is required to support and promote exclusive breastfeeding.