Psychoneuroimmunological Pathways from HIV Serodiscordance to Fetal Growth Restriction: A Scoping Review and Conceptual Framework

HIV serodiscordance, where one partner is HIV positive, and the other remains uninfected, continues to shape reproductive health decisions for millions of couples worldwide. Despite advances in antiretroviral therapy, pre-exposure prophylaxis, and prevention of mother-to-child transmission programs, these couples face persistent psychosocial stressors that influence maternal and fetal outcomes. Fetal growth restriction remains a major contributor to perinatal morbidity and mortality, and growing evidence suggests that maternal HIV infection, antiretroviral exposure, and psychosocial adversity converge to alter placental function and impair fetal growth. This review applied a psychoneuroimmunological framework to integrate biomedical, psychosocial, and relational dimensions of HIV-affected pregnancies. A systematic search across PubMed, Embase, Web of Science, and Scopus from 2020 to 2025 identified 42 eligible studies. Data extraction focused on psychosocial instruments, neuroendocrine and immune biomarkers, placental pathology, and fetal growth outcomes. Findings were synthesized thematically across mechanistic domains. Results highlight that stigma, depression, and intimate partner violence elevate maternal stress and dysregulate the hypothalamic pituitary adrenal axis, leading to abnormal cortisol rhythms, heightened corticotropin-releasing hormone, and increased catecholamines. These changes, alongside elevated inflammatory cytokines and altered angiogenic factors, compromise placental vascular remodeling and nutrient transport. Doppler studies and histopathology confirm higher rates of uteroplacental malperfusion and villous lesions in HIV-positive pregnancies. Epidemiologic evidence links both maternal HIV and partner serostatus to reduced birthweight and small-for-gestational-age outcomes, with mediation analyses underscoring the role of stress biomarkers. Interventions such as antenatal counseling, partner involvement, and psychosocially supported PrEP programs show promise in reducing stress, improving adherence, and enhancing birth outcomes. However, critical gaps remain, particularly in longitudinal biomarker studies and culturally sensitive intervention trials in low and middle-income countries. This synthesis underscores the need for integrated approaches that address both biomedical and psychosocial pathways to improve maternal and child health in HIV-affected families.