Aflatoxin exposure in pregnant women of mixed status of human immunodeficiency virus infection and rate of gestational weight gain: a Ugandan cohort study.

Objectives To examine the association between aflatoxin (AF) exposure during pregnancy and rate of gestational weight gain (GWG) in a sample of pregnant women of mixed HIV status in Gulu, northern Uganda. Methods 403 pregnant women were included (133 HIV-infected on antiretroviral therapy (ART), 270 HIV-uninfected). Women's weight, height and socio-demographic characteristics were collected at baseline (similar to 19 weeks' gestation); weight was assessed at each follow-up visit. Serum was collected at baseline and tested for aflatoxin B-1-lysine adduct (AFB-lys) levels using high-performance liquid chromatography (HPLC). Linear mixed-effects models were used to examine the association between AFB-lys levels and rate of GWG. Results AFB-lys levels (detected in 98.3% of samples) were higher among HIV-infected pregnant women than HIV-uninfected pregnant women [median (interquartile range): 4.8 (2.0, 15.0)vs. 3.5 (1.6, 6.1) pg/mg of albumin,P < 0.0001]. Adjusting for HIV status, a one-log increase in aflatoxin levels was associated with a 16.2 g per week lower rate of GWG (P = 0.028). The association between AFB-lys and the rate of GWG was stronger and significant only among HIV-infected women on ART [-25.7 g per week per log (AFB-lys),P = 0.009 for HIV-infected womenvs. -7.5 g per week per log (AFB-lys),P = 0.422 for HIV-uninfected women]. Conclusions Pregnant women with higher levels of AF exposure had lower rates of GWG. The association was stronger for HIV-infected women on ART, suggesting increased risk.