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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 22
| Issue : 3 | Page : 373-380 |
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Association between maternal selenium levels and pregnancy outcome among human immunodeficiency virus-positive and human immunodeficiency virus-negative pregnant women in a tertiary health-care center in Owerri, Nigeria: A comparative cross-sectional study
Rasmus Izuchukwu Okonkwo1, Augustine Duke Onyeabochukwu2, Emmanuel Obiora Izuka3, Chukwunonyerem Precious Duke-Onyeabo4, Chinelo Elizabeth Obiora-Izuka5, Uchenna Terry Ejelonu1, Uchenna Ifeanyi Nwagha3
1 Department of Obstetrics and Gynaecology, Federal Medical Centre, Owerri, Nigeria
2 Department of Obstetrics and Gynaecology, Federal Medical Centre, Owerri; Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
3 Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital; Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
4 Department of Paediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria
5 Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla Campus, Enugu, Nigeria
| Date of Submission | 28-Jun-2022 |
| Date of Decision | 06-Jan-2023 |
| Date of Acceptance | 02-May-2023 |
| Date of Web Publication | 4-Jul-2023 |
Correspondence Address:
Augustine Duke Onyeabochukwu
Department of Obstetrics and Gynaecology, Federal Medical Centre, Owerri; Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/aam.aam_96_22
 Abstract | | |
Background: Human immunodeficiency virus (HIV) infection constitutes a major medical complication of pregnancy and is associated with adverse feto-maternal outcomes. However, the relationship between maternal serum selenium levels and pregnancy outcomes has been inconsistent. Objective: This study aimed to determine the relationship between maternal serum selenium status and pregnancy outcome in HIV-positive and HIV-negative women in a tertiary health facility. Methodology: A comparative cross-sectional study was carried out among HIV-positive and HIV-negative pregnant women at a tertiary health-care facility in Owerri. Participants were recruited from the labor ward and interviewed using a structured questionnaire. One hundred and ten HIV-positive pregnant women were compared with an equal number of HIV-negative pregnant women. They were matched for age, parity and gestational age. Selenium level was measured using atomic absorption spectrophotometer. Maternal packed cell volume (PCV) was also assessed at recruitment. At delivery, the birth weight was measured using a standard weighing scale and documented. Cases of preterm births, perinatal deaths, major congenital abnormalities, and neonatal admission were noted and also documented. Statistical analysis was performed using means and standard deviation. Chi-square test, Student's t-test, logistic regression, and Pearson correlation were also employed. Statistical significance was considered at P < 0.05. Results: HIV-positive pregnant women had significantly lower mean serum selenium concentration compared with HIV-negative pregnant women (64.3 ± 19.6 μg/L vs. 100.1 ± 30.9 μg/L; P < 0.001). There was a statistically significant association between serum selenium concentration and birth weight among both HIV-positive and HIV-negative pregnant women (P < 0.001). Similarly, a statistically significant association was seen between serum selenium and maternal PCV in HIV-positive and HIV-negative pregnant women (P = 0.024 and P < 0.001, respectively). However, there was no association found between serum selenium and other pregnancy outcomes. Conclusion: HIV-positive pregnant women had a lower mean serum selenium level compared to HIV-negative pregnant women. There was a significant association between low maternal serum selenium level and maternal anemia, as well as low birth weight, especially in HIV-positive pregnant women.
Résumé
Contexte: L'infection par le virus de l'immunodéficience humaine (VIH) constitue une complication médicale majeure de la grossesse et est associée avec des issues fœto-maternelles défavorables. Cependant, la relation entre les niveaux de sélénium sérique maternel et les résultats de la grossesse aété incohérent. Objectif: Cette étude visait à déterminer la relation entre le statut maternel en sélénium sérique et la grossesse résultat chez les femmes séropositives et séronégatives dans un établissement de santé tertiaire Méthodologie: une étude transversale comparative a été menée auprès de femmes enceintes séropositives et séronégatives dans un établissement de soins de santé tertiaires à Owerri. Les participants étaient recrutés dans la salle de travail et interrogés à l'aide d'un questionnaire structuré. Cent dix femmes enceintes séropositives ont été comparativement à un nombre égal de femmes enceintes séronégatives. Elles ont été appariées pour l'âge, la parité et l'âge gestationnel. Le niveau de sélénium a été mesuré à l'aide d'un spectrophotomètre d'absorption atomique. L'hématocrite maternel (PCV) a également été évalué à recrutement. À l'accouchement, le poids à la naissance a été mesuré à l'aide d'une balance standard et documenté. Des cas de naissances prématurées, de décès périnataux, d'anomalies congénitales majeures et d'admissions néonatales ont été notés et également documentés. L'analyse statistique a été effectuée à l'aide des moyennes et des normes déviation. Le test du chi carré, le test t de Student, la régression logistique et la corrélation de Pearson ont également été utilisés. La signification statistique était considéré à P < 0,05. Résultats: Les femmes enceintes séropositives avaient une concentration sérique moyenne de sélénium significativement plus faible que avec des femmes enceintes séronégatives (64,3 ± 19,6 μg/L vs 100,1 ± 30,9 μg/L ; P < 0,001). Il y avait une association statistiquement significative entre la concentration sérique de sélénium et le poids à la naissance chez les femmes enceintes séropositives et séronégatives (P < 0,001). De la même manière, une association statistiquement significative a été observée entre le sélénium sérique et l'hématocrite maternel chez les femmes enceintes séropositives et séronégatives.femmes (P = 0,024 et P < 0,001, respectivement). Cependant, aucune association n'a été trouvée entre le sélénium sérique et d'autres grossesses. Résultats. Conclusion: les femmes enceintes séropositives avaient un taux sérique moyen de sélénium par rapport aux femmes enceintes séronégatives femmes. Il y avait une association significative entre la faible taux sérique de sélénium et anémie maternelle, ainsi que faible taux de naissance poids, en particulier chez les femmes enceintes séropositives.
Mots-clés: enceinte séronégative pour le virus de l'immunodéficience humaine femmes, femmes enceintes séropositives pour le virus de l'immunodéficience humaine, taux de sélénium maternel, résultat de la grossesse
Keywords: Human immunodeficiency virus-negative pregnant women, human immunodeficiency virus-positive pregnant women, maternal selenium levels, pregnancy outcome
How to cite this article:
Okonkwo RI, Onyeabochukwu AD, Izuka EO, Duke-Onyeabo CP, Obiora-Izuka CE, Ejelonu UT, Nwagha UI. Association between maternal selenium levels and pregnancy outcome among human immunodeficiency virus-positive and human immunodeficiency virus-negative pregnant women in a tertiary health-care center in Owerri, Nigeria: A comparative cross-sectional study. Ann Afr Med 2023;22:373-80 |
How to cite this URL:
Okonkwo RI, Onyeabochukwu AD, Izuka EO, Duke-Onyeabo CP, Obiora-Izuka CE, Ejelonu UT, Nwagha UI. Association between maternal selenium levels and pregnancy outcome among human immunodeficiency virus-positive and human immunodeficiency virus-negative pregnant women in a tertiary health-care center in Owerri, Nigeria: A comparative cross-sectional study. Ann Afr Med [serial online] 2023 [cited 2023 Sep 26];22:373-80. Available from: https://www.annalsafrmed.org/text.asp?2023/22/3/373/380171 |
| Introduction | |  |
Human immunodeficiency virus (HIV) infection has remained a major public health challenge in sub-Sahara Africa, accounting for over two-thirds of the global estimate of persons living with HIV/AIDS.[1],[2] An estimated 25.5 million people living with HIV (PLWHIV) live in sub-Saharan Africa. Nigeria has an estimated 3.4 million PLWHIV, second only to that in South Africa.[3] In 2012, 388,864 new HIV infections were reported with approximately 217,148 AIDS-related deaths in the same year.[4] In this regard, Nigeria bears nearly 10% of the global burden of HIV/AIDS.[3]
Some studies[5],[6],[7] found an association between HIV infection in pregnancy and increased rates of low birth weight (LBW), prematurity, miscarriage, maternal anemia, perinatal deaths, birth asphyxia, neonatal admission, and congenital abnormality.
It is well established that the nutritional well-being of a healthy mother is critical for an uncomplicated pregnancy and positive outcome.[8],[9] Nutritional status has even greater implications for the HIV-infected woman who is at a higher risk of delivering a premature or LBW infant and of being malnourished than the uninfected woman.[8]
Selenium is an essential trace element which is nutritionally essential for humans and plays a central role in DNA synthesis and protection from oxidative damage and infection.[10] Selenium functions in oxidative defense, such as in the glutathione peroxidase (GSH-Px) enzyme system.[11] Poor selenium status lowers GSH-Px activity,[12] which may lead to oxidative stress followed by apoptosis of T-lymphocytes and increased HIV replication rates.[13] During embryonic and fetal development, oxidative stress may damage DNA and cell membranes with associated dire consequences.[13]
In normal pregnancy, selenium functions as an antioxidant and plays a role in oxidoreductase reactions. A study conducted in Enugu by Nwagha et al.[9] found that the mean selenium level decreased as pregnancy advanced, and they concluded that dietary intake should be modified to ensure optimal selenium levels during pregnancy. Another study by Ejezie et al.[14] found that the mean selenium levels were significantly decreased in pregnancy when compared with nonpregnant control subjects as the pregnancy progressed and, after birth, as lactation progressed. They advocated for dietary intervention in the form of food diversification and biofortification.
Selenium levels are often low in PLWHIV, possibly due to inadequate intake and excessive losses due to diarrhea and malabsorption.[10] Some studies from Turkey and Tanzania,[15],[16] have shown that low maternal serum selenium concentration was related to adverse pregnancy outcomes such as LBW, neural tube defects, miscarriages, and poor weight gain during pregnancy. Kupka et al.[13] demonstrated the significance and benefit of micronutrient supplements in HIV- positive pregnant women.
Makwe et al.[17] conducted a similar study in Lagos but they only determined the relationship between serum selenium and birth weight among HIV-positive pregnant women. This study considered other pregnancy outcomes aside from birth weight such as perinatal deaths, maternal packed cell volume (PCV), neonatal admission, and major congenital abnormality. Confounding variables like smoking which was not excluded in Makwe's study was excluded in our study. In this study, the laboratory clinical chemistry cutoff for serum selenium was used, whereas Makwe et al.[17] derived their cutoff from previous studies.[17] In our study, we compared selenium status in labor while Makwe et al.[17] and Okunade et al.[18] analyzed the selenium status of women that are not in labour. Okunade et al. found selenium deficiency in 20.4% of their study participants who were pregnant women with HIV in Lagos, Nigeria. In their study, women with selenium deficiency had an approximately 8-fold higher risk of preterm delivery and of delivering a term neonate with LBW compared with women with a normal selenium concentration. For the studies by Makwe et al. and Okunade et al., serum selenium levels of the participants are at risk of alteration by some factors within the long period before labor.
Apart from these shortcomings of the Nigerian study, there have been varying reports worldwide on the role of selenium status in the outcome of pregnancy among HIV-infected women.[13],[15],[17],[19] These shortcomings of the Nigerian reports and the varying reports worldwide on the role of selenium status on outcome of pregnancy, necessitated the need for this study, to find out the relationship between maternal selenium and the outcome of pregnancy in HIV – Positive pregnant women.
| Methodology | | |
Study area
The study was conducted at the labor ward of Federal Medical Centre (FMC), Owerri, Imo State, South-East Nigeria. Imo State has an estimated population of about 4.6 million people with about 470,000 of them, residing in the Owerri area. An estimated 130,000 (26.87%) of these are women of reproductive age.[20] FMC, Owerri, is a tertiary health facility which provides health care to the people in the city of Owerri as well as neighboring towns and semi-urban settlements. It also receives patronage from other big cities such as Aba and Umuahia in Abia State, and Port Harcourt in Rivers State. The average antenatal attendance rate in the center per month is 3058. An average of 240 deliveries take place every month in its labor ward. An average of 80 HIV-positive pregnant women attend antenatal clinic monthly while an average of 20 HIV pregnant women deliver monthly in the facility.
Study design
This was a comparative cross-sectional study.
Study population
The study population consists of eligible parturients at the labor ward of FMC, Owerri, who gave informed consent. They consist of two groups: HIV-positive parturients/newborns and HIV-negative parturients/newborns.
Ethical consideration
The ethical clearance and permission to conduct this study were obtained from the Ethical Committee of FMC, Owerri. Written informed consent was also obtained from all participants. Excluded patients and all participants received treatment according to existing protocols. The results of the investigation performed in this study were communicated to the participants during subsequent visits. The cost of prosecuting the research were borne entirely by the authors.
Inclusion criteria
Parturients with singleton pregnancy in labor after 28-week gestation who tested positive to both Determine and Uni-Gold HIV test kits and who gave informed consent and parturients with singleton pregnancy in labor after 28-week gestation who tested negative to Determine HIV test kit and who gave informed consent were included in the study.
Exclusion criteria
Parturients with chronic medical conditions, pregnancy-induced hypertension, and gestational diabetes were excluded from the study. Patients who used tobacco, were alcoholics, or were on protease inhibitors were also excluded.
Sample size determination
The sample size was determined using the formula:[21] n = Z2pq/d2
If we use a prevalence of 7.5% from a previous study done in Owerri,[22] the calculated sample size will be 220. Therefore, 110 participants were recruited from each group.
Standardization of research team/pretesting of questionnaire
Three junior resident physicians were trained and used as research assistants. All interviews and measurements were made by the researcher with the help of the three research assistants. The research pro forma was pretested at General Hospital Umuguma, Imo State, with 25 respondents and standardized before the main study to ascertain its challenges or ambiguity. At the end of the survey, all ambiguous questions were corrected.
Sampling method and technique
Consecutive consenting eligible HIV-positive pregnant women were recruited for the first group until the minimum sample size of 110 participants was reached. Following each recruitment, the next presenting, consenting, and eligible HIV-negative parturients matched for parity and gestational age were recruited for the second group.
Study procedure and data collection
Following recruitment, a research pro forma was administered by the investigator or a trained assistant to obtain participants' personal information including last menstrual period, parity, sociodemographic data, past obstetric and medical histories, expected date of delivery, daily drug use, and types. The antenatal records were reviewed including CD4+ cell count, PCV, and admissions in pregnancy if any. The weight and height were measured using a RGZ 160 model weighing scale and stadiometer (manufactured by Pyrochy Medical, UK).
Venipuncture was performed after cleaning the skin overlying the veins with methylated spirit, and 6 mL of blood was collected using a syringe and needle; 5 mL was transferred into a plain bottle for serum selenium estimation and 1 mL into an ethylenediaminetetraacetic acid bottle for PCV. The blood collection was carried out by the investigator and assistants trained for the study. The blood sample was left to stand for 15 min. After clot retraction, the sample in the plain bottle was spun at 3000 rpm for 10 min. The supernatant was collected and stored in a refrigerator at the clinical chemistry laboratory unit of FMC, Owerri, at −20°C until analysis.
Following delivery, the mode of delivery, infant birth weight, calculated gestational age in weeks at delivery, and pregnancy outcome were obtained. Birth weight was measured by the investigator or attending midwives to the nearest 10 g on a Waymaster infant spring weighing scale (model 1960, manufactured in the UK in 2017) calibrated in kilograms, immediately after delivery. The weighing instrument was standardized by using predetermined weights to check for the precision of measurement. LBW was defined as birth weight <2500 g and normal weights as 2500–4000 g. Macrosomia was defined as birth weight >4000 g. Maternal anemia was defined as PCV of <30% and preterm birth was taken as births before 37 completed weeks. The presence of major congenital malformation and perinatal death were recorded. The study lasted for 10 months. The scale was set at 0 before the newborn was put on it immediately after cleaning and while the newborn was still naked. The weighing was repeated twice by the nurse on duty. A third measurement was obtained if the weight measurements varied by more than 0.2 kg by the researcher. An average of the two closest readings was taken. The weighing scale was calibrated using a standard weight of 5 kg every morning.
Biochemical analysis of the sample
The mean serum selenium level in normal pregnant subjects ranges between 70 and 120 μg/L. The level of selenium was estimated using Single Beam DW-AA4530F Atomic Absorption Spectrophotometer by Drawell, China, manufactured in 2017. The analysis was carried out by the investigator at the Projects Development Institute (PRODA), Enugu, in conjunction with their laboratory scientist under the supervision of a chemical pathologist. The sample was transported in batches of 20 from Owerri to PRODA, Enugu, in a cold-chain box. To ensure quality control, commercially prepared samples were used to ensure that the same sensitivity and specificity were maintained throughout the analysis.
Statistical analysis
The data were analyzed using the Statistical Package for the Social Sciences IBM SPSS version 21 (Chicago, Illinois, USA). Demographic and baseline variables were summarized using descriptive statistics expressed as mean (standard deviation) or median (interquartile range) for continuous variables and percentages for categorical variables. Comparison of continuous variables was done using the Student's t-test, and categorical variables were compared using the Chi-square test. Furthermore, logistic regression analysis and Pearson correlation were done to find the strength of association between maternal selenium level and pregnancy outcome. Statistical significance was considered when P < 0.05.
| Results | | |
A total of 220 women were recruited for this study. HIV-positive respondents were 110 and HIV-negative respondents were 110.
[Table 1] shows statistical significance only in educational level (P < 0.001) and socioeconomic status (P < 0.001) of respondents.
[Table 2] shows that the mean maternal selenium of HIV-positive respondents was found to be statistically significantly different from the mean of HIV-negative respondents (HIV positive 64.29 ± 19.63 vs. HIV negative 100.14 ± 30.91), P < 0.001. | Table 2: Comparison of mean maternal selenium level between human immunodeficiency virus-positive and human immunodeficiency virus-negative women
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[Table 3] shows a statistical significant association between maternal serum selenium and maternal anemia (P = 0.024). Similarly, a statistically significant association was also seen in the association between maternal serum selenium and birth weight with P < 0.001. However, there was no statistically significant association found between maternal serum selenium and gestational age at delivery, and other fetal outcomes. | Table 3: Association between maternal serum selenium level and pregnancy outcome in human immunodeficiency virus-positive respondents
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[Table 4] shows a statistical significant association between maternal serum selenium and maternal anemia with P < 0.001. Similarly, a statistically significant association was also seen between maternal serum selenium and birth weight with P < 0.001. However, there was no statistically significant association found between maternal serum selenium and Gestational age at delivery, and other fetal outcomes. | Table 4: Association between maternal serum selenium level and pregnancy outcome in human immunodeficiency virus-negative respondents
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[Table 5] shows a positive relationship between maternal serum selenium and birth weight in HIV-negative respondents which was statistically significant (P < 0.006). A positive relationship was also seen between maternal serum selenium and maternal PCV in HIV-negative respondents who were also statistically significant (P < 0.001). A negative correlation was also seen to exist between maternal serum selenium and maternal PCV (P < 0.305) in HIV-positive respondents, but this was not statistically significant. The table also shows a positive relationship between maternal serum selenium and birth weight in HIV respondents. This was found to be statistically significant (P < 0.001). | Table 5: Pearson correlation coefficient (r) of maternal serum selenium, birth weight, and packed cell volume in human immunodeficiency virus-positive and human immunodeficiency virus-negative respondents
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| Discussion | | |
The objective of this study was to find the relationship between selenium and pregnancy outcome in HIV-positive pregnant women, and our study showed that the mean serum selenium concentration in HIV-positive pregnant women was significantly lower than that in HIV-negative pregnant women. The mean serum selenium level in HIV-negative pregnant women was higher than in HIV-positive pregnant women. This finding is consistent with other studies that found lower serum selenium levels in HIV-infected individuals when compared to HIV-uninfected individuals.[17],[23] Undeniably, nutritional insufficiencies are prevalent among HIV-infected people due to the oxidative state induced by the virus, malabsorption, metabolic alterations, gut infections, and gut barrier dysfunction. These increases the demand and utilization of selenium in HIV-positive pregnant when compared to HIV-negative women.
This study demonstrated a statistically significant association between maternal anemia and low serum selenium among HIV-positive respondents. Likewise, a statistically significant association between maternal anemia and low serum was also found among HIV-negative respondents. This finding supports the hypothesis that selenium plays a vital role in erythropoiesis and erythrocyte functioning. The association between serum selenium and maternal anemia, as was found in this study, is at variance with other studies,[24],[25] but it was similar to the findings by Oster et al.,[26] Padmaja et al.,[27] and Tsvelina et al.[28] The three possible explanations could be through the biological mechanism which has been suggested for the involvement of selenium deficiency in the development of anemia: increased oxidative stress, modulation of inflammation through induction of the proinflammatory cytokine interleukin-6, and increased expressions of heme oxygenase-1. In other words, low serum selenium has been shown to result in poor absorption of iron and reduction of erythrocyte lifespan due to increased lipid peroxidation.
The current study showed a significant association between low serum selenium levels and LBW among HIV-positive respondents. Similarly, an association between low serum selenium levels and LBW was also seen among HIV-negative respondents. These were statistically significant. In studies from Zaire[29] and Tokyo[30] among women who presumably did not have HIV, the selenium levels were lower among women who delivered neonates with a delivery weight of <2500 g. This result is consistent with the finding in the present study. However, this is contradicting the finding of the study that was carried out by Makwe et al.[17] in Lagos. The difference can be explained by the different cutoffs for selenium deficiency used in the present study and that by Makwe et al.[17] The cutoff value chosen by Makwe et al.[17] was 85 μg/L which was based on previous studies of HIV selenium status, whereas, in this study, the cutoff value of 70 μg/L was based on the lower limit of the reference range for normal selenium levels in a standard clinical chemistry textbook.[31] Another possible explanation could be the timing of maternal blood collection for evaluation of serum selenium. The sample in the present study was collected while the patients were in labor, whereas the sample was collected between 14 weeks and 26 weeks in Makwe et al.[17] and Okunade et al.[18] This means that they have to wait for a long period to analyze the pregnancy outcome following delivery. The serum selenium level stands the risk of being affected by some factors within this long interval.
Reduced selenium concentrations seem to be related to gross congenital anomalies such as neural tube defects, as was reported by Cengiz et al.[16] This was in contrast to the current study which could not demonstrate any association between low maternal serum selenium and a gross congenital anomaly among HIV-positive pregnant women. There was no congenital anomaly seen among HIV-negative respondents in this study. Zeyrek et al.[32] did not find any association between gross congenital anomaly and low serum selenium in their study, just like in the present study. Moreover, the findings by Cengiz et al.[16] may be due to different population groups and a small sample size of 28, even though it was hypothesized that women with low selenium status and low levels of folate could worsen oxidative stress, and thus, purine and pyrimidine synthesis could be jeopardized.
This study did not demonstrate any association between serum selenium deficiency and fetal death in both HIV-positive pregnant women and HIV-negative pregnant women. This finding corroborated with the results from the study carried out in Lagos.[18] However, this is at variance with findings from Kupka et al.,[15] who reported an association between low maternal serum selenium concentration and fetal death. The difference can be explained by the fact that their study was an experimental study with a different methodology.
The results of this study which showed statistically significant associations were further subjected to linear regression to evaluate the relationship between these variables. Following this, a negative correlation was found between maternal serum selenium and maternal PCV among HIV-positive pregnant women. A statistically significant positive correlation was found between maternal serum selenium and PCV among HIV-negative pregnant women. This result is in keeping with the findings by Oster et al.[26] but was at variance with the result of the study that was conducted in Turkey.[25] This may be due to the different methods used in assessing selenium levels. The spectrofluorometric method was used in their study while atomic absorption spectrophotometry was used in this present study. There is a need for further studies to be conducted on this.
This study also showed a statistically significant positive correlation between maternal serum selenium and birth weight among HIV-positive pregnant women. There was also a statistically significant positive correlation between maternal serum selenium and birth weight among HIV-negative pregnant women. This study corroborates with findings from the work by Okunade et al.[18] but was not in keeping with the findings from Makwe et al.[17] This may be due to the different cutoffs of selenium used in the studies and different methods used in assessing selenium. This calls for further research in this area.
The limitation of the study is that it is a hospital-based and not a population-based study and therefore, its findings cannot be generalized to the entire population of HIV-positive women in Nigeria. Furthermore, because of the cross-sectional nature of the study, the associations identified might be difficult to interpret. Randomization instead of consecutive sampling is also a limitation. Another limitation of this study is the possibility that some subjects may have been on antenatal multivitamin supplementation which might contain micronutrients such as selenium. This may lead to a raised selenium concentration in them compared to nonusers. The dietary recall was not done to ascertain the diets the patients were on as some may be on diets rich or low in selenium. The socioeconomic status of the two groups may have varied significantly. However, despite these limitations, some strengths could be drawn from this study. First, the fact that the HIV-positive pregnant women who participated in the study had a control group helped to reduce bias. Second, the cutoff of serum selenium used in this study is from the lower limit of the standard laboratory range of serum selenium (70–120 μg/L) unlike most studies that used cutoffs based on findings from other studies. The logistic regression and Pearson correlation employed added strength to this study. Based on the findings from this study, there is a need to carry out a randomized experimental study where the effect of antenatal selenium supplementation on maternal PCV and birth weight among HIV-positive pregnant women will be studied. The results of such studies will serve as a template for policymakers to consider including prophylactic selenium supplementation during the antepartum period to improve pregnancy outcomes among HIV-positive pregnant women.
| Conclusion | | |
This study showed that HIV-positive pregnant women had a lower mean serum selenium level compared to HIV-negative pregnant women. There was a significant association observed between low maternal serum selenium level and maternal anemia, as well as LBW, especially in HIV-positive pregnant women. Thus, selenium supplementation may reduce maternal anemia and LBW in HIV-positive pregnant women.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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