Pregnancy is a period that imposes increased nutritional needs, and adequate nutrition is paramount for the health of the mother and the unborn child, when women must consume specific foods, variety, and quantity, taking into account cultural dietary guides and practices to meet energy and nutritional needs, and weight gain recommendations . Despite the need for increased energy intake during pregnancy, women living in underdeveloped countries are often exposed to food insecurity and, to long-term malnutrition; food insecurity combined with malnutrition can affect the growth and development of the fetus . Food insecurity is present in the lives of pregnant women in Africa because a large proportion of these women are responsible for family income and, during the period of pregnancy, their potential for income gain decreases, leading to a period of vulnerability and, in many cases, food insecurity leads to depression, a factor that impairs the well-being of both mother and baby .
The World Health Organization (2016) has published recommendations on prenatal care for a positive pregnancy experience, where it recommends that in undernourished populations, women receive nutritional education during pregnancy, guiding them to increase their daily energy and protein intake to reduce the risk of low birth weight newborns. The same document also recommends a daily oral supplementation of iron and folic acid with 30 to 60 mg of elemental iron and 400μg (0.4 mg) of folic acid in order to avoid anaemia of mothers, puerperal infection, low birth weight and premature birth .
The presence of Human Immunodeficiency Virus (HIV) in the pregnancy does not reduce positive feelings about motherhood, but imposes many fears and strict care to prevent vertical transmission, particularly during birth . When a HIV- positive woman becomes pregnant, some additional aspects must be considered in relation to her nutritional status, because the energetic demands of this woman are determined by the high energetic expenditure of rest, in the occurrence of infection and by the physiological adjustments proper to the gestational process, so that the increase in nutritional needs should reflect both the demands of pregnancy and infection . Nutritional alterations, such as weight loss and protein reduction are common in HIV infection, alterations that lead to malnutrition, which results in a weakened immune system, requiring multivitamin supplementation during pregnancy and in the postpartum period, which significantly improve the hematological status of HIV-infected women as well as their children . Experiences of guilt and fear of transmitting HIV to the child add to the health policies and actions that contribute to motherhood prophylaxis , the challenge posed by the HIV/AIDS epidemic in Africa, Angola, through the support of UNAIDS and the UN, support the initiative of the 37 First Ladies of African countries, whose program named "Born Free to Shine" has sought to offer treatment conditions to HIV-positive pregnant women in order to reduce the rate of mother-to-child transmission of HIV by offering them quality and humane care services .
It is estimated that between 223.350 and 290.000 adults over the age of 15 live with HIV in Angola, in addition to almost 30.000 children, in a prevalence of 2.34% among adults aged 15-49. It is estimated that women living with HIV, having a higher prevalence among young women (15-24 years = 0.9%), and about 15.575 pregnant women test positive for HIV each year, in a national average prevalence of 15-49 age group in 2.8%, being higher in the urban area (3%) than in the rural area (1.6%) .
Hence the need to carry out this study, with the objective of conducting nutritional assessment in the pre-gestational and gestational stages of HIV-positive women, in order to verify how much the results of these assessments may indicate risks of morbidity and mortality in these women, taking into account the various changes that guess the HIV infection and the maternal nutritional status, and the fact that there is no nutritional monitoring directed to these pregnant women in Angola until the time of the study.