Associations between maternal lipid profiles and cardiovascular and metabolic outcomes among children who are HIV-exposed uninfected versus HIV-unexposed children aged 5–8 years in a South African birth cohort

Objective: To evaluate the association between maternal gestational lipid biomarkers and cardiometabolic health indicators in Children who are HIV-Exposed Uninfected (CHEU) and HIV-Unexposed Uninfected (HU) children. Design: Prospective Cohort Study Methods: Our study randomly sampled 260 mother-child pairs from Drakenstein Child Health Study (N = 100 CHEU & N = 160 HU). Multivariable linear regression were used to assess associations between maternal lipid biomarkers from second trimester of pregnancy with child cardiometabolic indicators at 5–8 years of age and explored potential effect modification by HIV exposure status in stratified analyses. Child cardiometabolic indicators included lipids, glucose metabolism, blood pressure, and body composition. Results: Associations were found between maternal total cholesterol (TC) and child TC and low-density lipoprotein (LDL) [TC; mean difference [MD] 0.19, 95% CI 0.09, 0.30] & [LDL; MD 0.21, 95% CI 0.12, 0.31]. When stratified by HIV exposure status, the relationship between maternal TC and child TC was stronger in CHEU children than in HU children. The relationship between maternal TC and child LDL was also observed to be stronger in CHEU. Maternal high-density lipoprotein (HDL) was associated with the child HDL levels [MD 0.13, 95% CI 0.03, 0.23]; when stratified, this association was only demonstrated in HU children. No significant associations were found between maternal lipids and child HbA1c, insulin resistance, systolic or diastolic blood pressure or body composition. Conclusions: In a birth cohort of South African CHEU and HU children, maternal gestational lipid profiles was associated with child lipid metabolism, and this relationship may differ based on in-utero HIV exposure status.