Folate intake and associated predictors among pregnant women living with and
without HIV in the Klipfontein-Mitchells Plain sub-district, South Africa: A cross

Nhlapo, Pieriette

Folate intake and associated predictors among pregnant women living with and without HIV in the Klipfontein-Mitchells Plain sub-district, South Africa: A cross

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Public Health and Family Medicine

Faculty

Faculty of Health Sciences

Abstract

Objectives: The objectives were to describe dietary folate intake and folic acid supplementation status among pregnant women living with HIV (WLHIV) and without HIV (WLWHIV), to identify predictors of intake including but not limited to socio-economic status, food security, anxiety disorder and gastrointestinal (GI) tract symptoms, and to identify predictors of meeting recommended levels. Design: This cross-sectional study used secondary data from the Obesogenic Origins of Maternal and Child Metabolic Health involving Dolutegravir (ORCHID), longitudinal cohort study. Setting: The study was conducted at two maternity obstetric units in the Klipfontein-Mitchells Plain sub-district. Participants: Pregnant women (n =1920, ≥ 16 years, ≤ 22 weeks' gestation) from the ORCHID study's enrolment visit were included. Results: Among the participants, 41.9% were WLHIV and 58.1% WLWHIV. The median gestational age was 13 weeks (IQ, 9.0-15.0). Only 8.2% met folate levels through diet alone. While 63.6% reported daily folic acid supplementation, this was more prevalent among WLHIV. Multivariable linear and logistic regression analyses indicated that WLHIV consumed more dietary folate (0.02 μg/day; CI -18.5, 18.6) and had a higher adjusted odds of daily folic acid supplementation (aOR: 1.5; CI 1.3, 1.9). Dietary folate intake was associated with age, gestational age (GA) and total energy intake, while supplementation associated with GA, education and anxiety disorder. No significant association was found with hunger. Conclusion: The women showed a significant gap in meeting recommended dietary folate levels, with many missing the critical window for folic acid supplementation. Interventions focusing on improved food systems, promoting preconception care and early antenatal attendance are urgently needed.