Aflatoxin B1 and fumonisin B1 exposure and adverse birth outcomes in HIV-infected and HIV-uninfected women from Harare, Zimbabwe.

Aflatoxin B₁ (AFB1) and fumonisin B₁ (FB1) are toxic secondary products of fungi that frequently contaminate staple crops in resource-limited settings. Antenatal AFB1 and FB1 exposure may cause adverse birth outcomes. We conducted a retrospective substudy nested in a case-control cohort of HIV-infected and HIV-uninfected women ≥20 weeks gestation from Harare, Zimbabwe. Urinary aflatoxin M₁ (AFM1) and FB1, biomarkers of AFB1 and FB1 exposure, respectively, were quantified in random antenatal urine via ELISA and grouped into tertiles. The adverse birth outcomes considered were low birth weight, preterm birth (PTB), small for gestational age, stillbirth, birth defects, neonatal death, neonatal jaundice and perinatal death (PD). We evaluated any associations between adverse birth outcomes and exposure to AFB1, FB1, or the AFB1-FB1 combination via a multivariable logistic regression controlled for potential confounders. We enrolled 94 HIV-infected and 81 HIV-uninfected women. In HIV-infected, AFM1 was detected in 46/94 (49%), and FB1 was detected in 86/94 (91%). In HIV-uninfected, AFM1 was detected in 48/81 (59%), and FB1 was detected in 74/81 (91%). Among all women, AFM1 tertile 3 was associated with PD (OR: 6.95; 95% CI: 1.21-39.78). In the same population, AFM1 tertiles 2 (OR: 13.46; 95% CI: 1.20-150.11) and 3 (OR: 7.92; 95% CI: 1.08-58.19) were associated with PTB. In HIV-infected, AFM1 tertile 2 was associated with PTB (OR: 64.73; 95% CI: 2.37-177.93). Our results revealed an association between AFB1 exposure and PD and PTB in women, including those infected with HIV. Public health and nutrition measures are necessary to mitigate mycotoxins.