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Associations Between Social Support and Symptoms of Antenatal Depression with Infant Growth and Development Among Mothers Living with HIV in Tanzania

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Abstract

Children born to mothers living with HIV may experience greater risk of poor growth and development outcomes than their HIV-unexposed peers. Few studies have examined the relationship between maternal depression and social support with infant growth and development in the context of HIV. We conducted a prospective cohort study of 2,298 pregnant women living with HIV in Dar es Salaam, Tanzania, assessing antenatal depression (Hopkins Symptoms Checklist-25) and social support (Duke–UNC Functional Social Support Questionnaire) at 12–27 weeks of gestation. At one-year age, infant anthropometry and caregiver-reported infant development were assessed. Generalized estimating equations were used to assess mean differences (MD) and relative risks (RR) for growth and developmental outcomes. Symptoms consistent with maternal antenatal depression had 67% prevalence and were associated with infant wasting (RR 2.61; 95% confidence interval (CI) 1.03–6.65; z = 2.02; p = 0.04), but no other growth or developmental outcomes. Greater maternal social support was not associated with infant growth outcomes. Greater affective support was associated with better cognitive (MD 0.18; CI 0.01–0.35; z = 2.14; p = 0.03) and motor (MD 0.16; CI 0.01–0.31; z = 2.04; p = 0.04) development scores. Greater instrumental support was associated with better cognitive (MD 0.26; CI 0.10–0.42; z = 3.15; p < 0.01), motor (MD 0.17; CI 0.02–0.33; z = 2.22; p = 0.03), and overall (MD 0.19; CI 0.03–0.35; z = 2.35; p = 0.02) development scores. Depressive symptoms were associated with greater risk of wasting, while social support was associated with better infant development scores. Strategies to improve mental health and social support for mothers living with HIV during the antenatal period may benefit infant growth and development.

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Data Availability

Data cannot be shared publicly because of requirement for ethical approval and data transfer agreement. The deidentified dataset supporting this research may be made available following a submitted request to ghp@hsph.harvard.edu and completion of ethical approval and data transfer agreement from the Tanzania National Institute of Medical Research (http://reims.nimr.or.tz:8010/guides/DTA.pdf).

Code Availability

Available for review upon reasonable request.

Change history

  • 15 May 2023

    Karim P Manji and Christopher R Sudfeld are joint senior authors.

References

  1. Smith Fawzi MC, Andrews KG, Fink G, Danaei G, McCoy DC, Sudfeld CR, et al. Lifetime economic impact of the burden of childhood stunting attributable to maternal psychosocial risk factors in 137 low/middle-income countries. BMJ Glob Heal. 2019;4(1):e001144.

    Article  Google Scholar 

  2. McCoy DC, Peet ED, Ezzati M, Danaei G, Black MM, Sudfeld CR, et al. Early Childhood Developmental Status in Low- and Middle-Income Countries: National, Regional, and global prevalence estimates using Predictive modeling. PLoS Med. 2016 Jun;13(6):e1002034.

  3. Sherr L, Croome N, Parra Castaneda K, Bradshaw K, Herrero Romero R. Developmental challenges in HIV infected children—An updated systematic review. Child Youth Serv Rev [Internet]. 2014;45:74–89. Available from: https://www.sciencedirect.com/science/article/pii/S0190740914001467.

  4. Danaei G, Andrews KG, Sudfeld CR, Fink G, McCoy DC, Peet E et al. Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels. PLOS Med [Internet]. 2016 Nov 1 [cited 2023 Mar 1];13(11):e1002164. Available from: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002164.

  5. Britto PR, Lye SJ, Proulx K, Yousafzai AK, Matthews SG, Vaivada T, et al. Nurturing care: promoting early childhood development. Lancet (London England). 2017 Jan;389(10064):91–102.

  6. Filteau S. The HIV-exposed, uninfected African child. Trop Med Int Health [Internet]. 2009 Mar [cited 2022 Jun 21];14(3):276–87. Available from: https://pubmed.ncbi.nlm.nih.gov/19171011/.

  7. Shapiro RL, Lockman S, Kim S, Smeaton L, Rahkola JT, Thior I et al. Infant morbidity, mortality, and breast milk immunologic profiles among breast-feeding HIV-infected and HIV-uninfected women in Botswana. J Infect Dis [Internet]. 2007 Aug 15 [cited 2022 Jun 21];196(4):562–9. Available from: https://pubmed.ncbi.nlm.nih.gov/17624842/.

  8. Afran L, Garcia Knight M, Nduati E, Urban BC, Heyderman RS, Rowland-Jones SL. HIV-exposed uninfected children: a growing population with a vulnerable immune system? Clin Exp Immunol [Internet]. 2014 Apr [cited 2022 Jun 21];176(1):11–22. Available from: https://pubmed.ncbi.nlm.nih.gov/24325737/.

  9. Growth TCI, Team N, CIGNIS) I. S. Micronutrient Fortification to Improve Growth and Health of Maternally HIV-Unexposed and Exposed Zambian Infants: A Randomised Controlled Trial. PLoS One [Internet]. 2010 [cited 2022 Jun 21];5(6):e11165. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0011165.

  10. Sudfeld CR, Lei Q, Chinyanga Y, Tumbare E, Khan N, Dapaah-Siakwan F et al. Linear Growth Faltering Among HIV-Exposed Uninfected Children. J Acquir Immune Defic Syndr [Internet]. 2016 Oct 1 [cited 2022 Jun 21];73(2):182–9. Available from: https://pubmed.ncbi.nlm.nih.gov/27116046/.

  11. Ntozini R, Chandna J, Evans C, Chasekwa B, Majo FD, Kandawasvika G, et al. Early child development in children who are HIV-exposed uninfected compared to children who are HIV-unexposed: observational sub-study of a cluster-randomized trial in rural Zimbabwe. J Int AIDS Soc. 2020 May;23(5):e25456.

  12. Wedderburn CJ, Weldon E, Bertran-Cobo C, Rehman AM, Stein DJ, Gibb DM et al. Early neurodevelopment of HIV-exposed uninfected children in the era of antiretroviral therapy: a systematic review and meta-analysis. Lancet Child Adolesc Heal [Internet]. 2022 Jun 1 [cited 2022 Aug 21];6(6):393–408. Available from: https://pubmed.ncbi.nlm.nih.gov/35483380/.

  13. Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158(5):725–30.

    Article  CAS  PubMed  Google Scholar 

  14. Kaaya SF, Fawzi MCS, Mbwambo JK, Lee B, Msamanga GI, Fawzi W. Validity of the Hopkins Symptom Checklist-25 amongst HIV-positive pregnant women in Tanzania. Acta Psychiatr Scand. 2002;106(1):9–19.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Surkan PJ, Kennedy CE, Hurley KM, Black MM. Maternal depression and early childhood growth in developing countries: systematic review and meta-analysis. Bull World Health Organ. 2011 Aug;89(8):608–15.

  16. Neamah HH, Sudfeld C, McCoy DC, Fink G, Fawzi WW, Masanja H et al. Intimate partner violence, depression, and child growth and development. Pediatrics. 2018;142(1).

  17. Liu Y, Kaaya S, Chai J, McCoy DC, Surkan PJ, Black MM, et al. Maternal depressive symptoms and early childhood cognitive development: a meta-analysis. Psychol Med. 2017;47(4):680–9.

    Article  CAS  PubMed  Google Scholar 

  18. Rodriguez VJ, Matseke G, Cook R, Bellinger S, Weiss SM, Alcaide ML, et al. Infant development and pre- and Post-partum Depression in Rural South African HIV-Infected Women. AIDS Behav. 2018 Jun;22(6):1766–74.

  19. Mebrahtu H, Simms V, Chingono R, Mupambireyi Z, Weiss HA, Ndlovu P, et al. Postpartum maternal mental health is associated with cognitive development of HIV-exposed infants in Zimbabwe: a cross-sectional study. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2018;30:74–82.

    Article  Google Scholar 

  20. Kaaya S, Garcia ME, Li N, Lienert J, Twayigize W, Spiegelman D, et al. Association of maternal depression and infant nutritional status among women living with HIV in Tanzania. Matern Child Nutr. 2016;12(3):603–13.

    Article  PubMed  Google Scholar 

  21. Ickes SB, Wu M, Mandel MP, Roberts AC. Associations between social support, psychological well-being, decision making, empowerment, infant and young child feeding, and nutritional status in Ugandan children ages 0 to 24 months. Matern Child Nutr [Internet]. 2018 Jan 1 [cited 2022 Oct 5];14(1):e12483. Available from: https://onlinelibrary.wiley.com/doi/full/https://doi.org/10.1111/mcn.12483.

  22. Lee HY, Song IH, Kawachi I. Maternal and child social support and food availability in relation to child growth in four low- and middle-income countries. Sci Rep [Internet]. 2022 Dec 1 [cited 2022 Jun 28];12(1). Available from: https://pubmed.ncbi.nlm.nih.gov/35396562/.

  23. Porta MS, Greenland S, Hernán M, Silva I dos S, Last JM. A dictionary of epidemiology. Six edition / edi... Porta MS, Greenland S, Hernán M, Silva I dos S, Last JM, editors. Oxford: Oxford University Press; 2014.

  24. Surkan PJ, Park S, Ridgeway K, Ribeiro M, Fidalgo TM, Martins SS et al. Caregiver Social Capital and Supportive Relationships are Associated with Better Child Social-Emotional Development. Child Psychiatry Hum Dev [Internet]. 2022 [cited 2022 Aug 23]; Available from: https://pubmed.ncbi.nlm.nih.gov/35088156/.

  25. Singla DR, Kumbakumba E, Aboud FE. Effects of a parenting intervention to address maternal psychological wellbeing and child development and growth in rural Uganda: a community-based, cluster randomised trial. Lancet Glob Heal [Internet]. 2015 [cited 2022 Aug 23];3(8):e458–69. Available from: https://pubmed.ncbi.nlm.nih.gov/26144389/.

  26. Sudfeld CR, Manji KP, Duggan CP, Aboud S, Muhihi A, Sando DM, et al. Effect of maternal vitamin D3 supplementation on maternal health, birth outcomes, and infant growth among HIV-infected Tanzanian pregnant women: study protocol for a randomized controlled trial. Trials. 2017;18(1):1–12.

    Google Scholar 

  27. Sudfeld CR, Manji KP, Muhihi A, Duggan CP, Aboud S, Alwy Al-Beity FM et al. Vitamin D3 supplementation during pregnancy and lactation for women living with HIV in Tanzania: A randomized controlled trial. PLOS Med [Internet]. 2022 Apr 15;19(4):e1003973. Available from: https://doi.org/10.1371/journal.pmed.1003973.

  28. Organization WH. Programmatic update: use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: executive summary. World Health Organization; 2012. p. 8.

  29. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974;19(1):1–15.

    Article  CAS  PubMed  Google Scholar 

  30. Winokur A, Winokur DF, Rickels K, Cox DS. Symptoms of Emotional Distress in a Family Planning Service: Stability over a Four-Week Period. Br J Psychiatry [Internet]. 2018/01/29. 1984;144(4):395–9. Available from: https://www.cambridge.org/core/article/symptoms-of-emotional-distress-in-a-family-planning-service-stability-over-a-fourweek-period/1C0020B1432C2DDB2E3A7CD2DDFFBE4D.

  31. Broadhead WE, Gehlbach SH, De Gruy FV, Kaplan BH. The Duke-UNC Functional Social Support Questionnaire: measurement of social support in family medicine patients. Med Care. 1988;26(7):709–23.

    Article  CAS  PubMed  Google Scholar 

  32. Antelman G, Kaaya S, Wei R, Mbwambo J, Msamanga GI, Fawzi WW, et al. Depressive symptoms increase risk of HIV disease progression and mortality among women in Tanzania. J Acquir Immune Defic Syndr. 2007;44(4):470–7.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Enrolment and baseline characteristics in the WHO Multicentre Growth Reference Study. Acta Paediatr Suppl [Internet]. 2006 Apr [cited 2023 Mar 20];450:7–15. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.library.tufts.edu/16817674/.

  34. McCoy DC, Waldman M, Fink G. Measuring early childhood development at a global scale: Evidence from the Caregiver-Reported Early Development Instruments. Early Child Res Q [Internet]. 2018;45:58–68. Available from: https://www.sciencedirect.com/science/article/pii/S0885200618300449.

  35. McCoy DC, Sudfeld CR, Bellinger DC, Muhihi A, Ashery G, Weary TE, et al. Development and validation of an early childhood development scale for use in low-resourced settings. Popul Health Metr. 2017 Feb;15(1):3.

  36. Regan M, Muhihi A, Nagu T, Aboud S, Ulenga N, Kaaya S, et al. Depression and viral suppression among adults living with HIV in Tanzania. AIDS Behav. 2021 Oct;25(10):3097–105.

  37. Sudfeld CR, Kaaya S, Gunaratna NS, Mugusi F, Fawzi WW, Aboud S, et al. Depression at antiretroviral therapy initiation and clinical outcomes among a cohort of Tanzanian women living with HIV. AIDS. 2017 Jan;31(2):263–71.

  38. Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, et al. Effects of perinatal mental disorders on the fetus and child. Lancet (London England). 2014 Nov;384(9956):1800–19.

  39. Regan M, Muhihi A, Saleh A, Duggan C, Ulenga N, Alwy Al-Beity FM et al. [Under review] Antenatal depression and adverse birth outcomes among pregnant women living with HIV in Dar es Salaam, Tanzania. 2023.

  40. Mikšić Å, Miškulin M, Juranić B, Rakošec Ž, Včev A, Degmečić D. Depression and Suicidality during Pregnancy. Psychiatr Danub [Internet]. 2018 [cited 2023 Mar 6];30(1):85–90. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.library.tufts.edu/29546863/.

  41. Tabb KM, Gavin AR, Faisal-Cury A, Nidey N, Chan YF, Malinga T et al. Prevalence of antenatal suicidal ideation among racially and ethnically diverse WIC enrolled women receiving care in a Midwestern public health clinic. J Affect Disord [Internet]. 2019 Sep 1 [cited 2023 Mar 6];256:278–81. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.library.tufts.edu/31195245/.

  42. Rodriguez VJ, Mandell LN, Babayigit S, Manohar RR, Weiss SM, Jones DL. Correlates of Suicidal Ideation During Pregnancy and Postpartum Among Women Living with HIV in Rural South Africa. AIDS Behav [Internet]. 2018 Oct 1 [cited 2023 Mar 6];22(10):3188–97. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.library.tufts.edu/29752621/.

  43. Miller LC, Neupane S, Sparling TM, Shrestha M, Joshi N, Lohani M et al. Maternal depression is associated with less dietary diversity among rural Nepali children. Matern Child Nutr [Internet]. 2021 Oct 1 [cited 2022 Jun 21];17(4). Available from: https://pubmed.ncbi.nlm.nih.gov/34132034/.

  44. Gebreyesus SH, Endris BS, Hanlon C, Lindtjorn B. Maternal depression symptoms are highly prevalent among food-insecure households in Ethiopia. Public Health Nutr [Internet]. 2018 Apr 1 [cited 2023 Mar 19];21(5):849–56. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.library.tufts.edu/29151371/.

  45. Sohr-Preston SL, Scaramella LV. Implications of Timing of Maternal Depressive Symptoms for Early Cognitive and Language Development. Clin Child Fam Psychol Rev 2006 91 [Internet]. 2006 Apr 25 [cited 2022 Oct 5];9(1):65–83. Available from: https://link.springer.com/article/https://doi.org/10.1007/s10567-006-0004-2.

  46. Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum depression: A synthesis of recent literature. Gen Hosp Psychiatry [Internet]. 2004 [cited 2023 Mar 6];26(4):289–95. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.library.tufts.edu/15234824/.

  47. Mukoswa GM, Charalambous S, Nelson G. The association between social capital and HIV treatment outcomes in South Africa. PLoS One [Internet]. 2017 Nov 1 [cited 2022 Aug 20];12(11):e0184140. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0184140.

  48. Perumal N, Roth DE, Cole DC, Zlotkin SH, Perdrizet J, Barros AJD et al. Effect of Correcting the Postnatal Age of Preterm-Born Children on Measures of Associations Between Infant Length-for-Age z Scores and Mid-Childhood Outcomes. Am J Epidemiol [Internet]. 2021 Mar 1 [cited 2022 Oct 30];190(3):477–86. Available from: https://academic.oup.com/aje/article/190/3/477/5893776.

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Funding

The trial was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) under Award Number R01 HD83113. CPD was partially funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) under grants K24 DK104676 and 2P30 DK040561. AS was supported by the National Institutes of Health Fogarty International Center and the NICHD under Award Number D43 TW010543. NP was supported by the Canadian Institutes of Health Research Fellowship Award and the Thrasher Research Foundation Early Career Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

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Author notes

  1. Karim P Manji and Christopher R Sudfeld are joint senior authors.

Authors and Affiliations

  1. Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA

    Arvin Saleh, Nandita Perumal, Wafaie W Fawzi & Christopher R Sudfeld

  2. Tufts University School of Medicine, Boston, MA, USA

    Arvin Saleh

  3. Africa Academy for Public Health, Dar es Salaam, Tanzania

    Alfa Muhihi

  4. Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    Alfa Muhihi

  5. Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA

    Christopher P Duggan, Wafaie W Fawzi & Christopher R Sudfeld

  6. Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Christopher P Duggan

  7. Management and Development for Health, Dar es Salaam, Tanzania

    Nzovu Ulenga

  8. Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    Fadhlun M Alwy Al-Beity

  9. Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    Said Aboud

  10. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Wafaie W Fawzi

  11. Department of Pediatrics and Child Health, Muhimbili University Health and Allied Sciences, Dar es Salaam, Tanzania

    Karim P Manji

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  1. Arvin Saleh
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Christopher R. Sudfeld, Karim P. Manji, Nandita Perumal, Alfa Muhihi, Said Aboud, Fadhlun M. Alwy Al-Beity, Nzovu Ulenga, Christopher P. Duggan, Wafaie W. Fawzi, and Arvin Saleh. The first draft of the manuscript was written by Arvin Saleh and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Arvin Saleh.

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Competing Interests

The authors have no competing interests to declare.

Ethics Approval

The parent trial was approved by the institutional review boards of Harvard T.H. Chan School of Public Health (IRB13-0231), the Muhimbili University of Health and Allied Sciences (2016-05-25/AEC/Vol.X/01), the Ethics Sub-Committee of the National Institute of Medical Research in Tanzania (NIMR/HQ/R.8a/Vol.IX/1658), and the Tanzania Food and Drugs Authority (TFDA13/CTR/0005/3).

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Saleh, A., Perumal, N., Muhihi, A. et al. Associations Between Social Support and Symptoms of Antenatal Depression with Infant Growth and Development Among Mothers Living with HIV in Tanzania. AIDS Behav 27, 3584–3595 (2023). https://doi.org/10.1007/s10461-023-04073-5

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