The triple burden of obesity, HIV, and anaemia during pregnancy and associations with delivery outcomes in urban South Africans

  • A Prioreschi SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
  • S V Wrottesley SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
  • L Adair Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
  • K A Ward MRC Lifecourse Epidemiology Unit, Human Development and Health, University of Southampton, Southampton General Hospital, Southampton, UK
  • S A Norris Global Health Research Institute, School of Health and Human Development, University of Southampton, Southampton General Hospital, Southampton, UK

Abstract

Objectives: First, to explore the independent associations between obesity, HIV (with ARV treatment), and anaemia and delivery outcomes in urban South African women and, second, to identify any potential interactions between these co-morbidities.
Design: Longitudinal observational cohort study.
Setting: Soweto, South Africa.
Subjects: Mother–infant pairs (789) were recruited when mothers were < 20 weeks pregnant.
Outcome measures: Infant gestational age at delivery was calculated, and infant birth weight and length were measured by trained research nurses. Head circumference was measured using a metal head circumference tape measure. Multivariable linear regression and logistic regression models were used to test the associations between obesity, HIV-positive status, and anaemia and delivery outcomes, as well as the potential interactions between the triple burden exposures.
Results: At baseline, 14%, 11%, and 22% of women were diagnosed with only obesity, HIV, or anaemia respectively, while 42% had two conditions and 5% were exposed to the triple burden. Maternal obese vs. non-obese status was associated with a 0.32 higher weight-to-length z-score at birth (p < 0.01) and a 2.93 times higher risk of a large-for-gestational age delivery (p < 0.01). There were no interactions between the triple burden exposures on delivery outcomes.
Conclusions: This study presents evidence for the importance of prioritising obesity prevention prior to conception in urban African settings such as South Africa. In addition, our findings highlight the need for more research into the complex relationships between maternal co-morbidities, as well as their potential influence (alone and in combination) on maternal and offspring health in the short and longer term.

Keywords: co-morbidities, health burden, neonate size, pregnancy health

Published
2025-06-19
How to Cite
Prioreschi, A., Wrottesley, S., Adair, L., Ward, K., & Norris, S. (2025). The triple burden of obesity, HIV, and anaemia during pregnancy and associations with delivery outcomes in urban South Africans. South African Journal of Clinical Nutrition, 38(2), 91-100. Retrieved from https://www.sajcn.co.za/index.php/SAJCN/article/view/2576
Issue
Vol 38 No 2 (2025)
Section
Original Research

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