Cardiometabolic Health in Pregnancy and Postpartum: Findings From a Prospective Cohort Study in South Africa

Abstract

Background The cardiometabolic impact of HIV infection and treatment with antiretroviral therapy (ART) in pregnancy and the postpartum period remains unclear. Methods We enrolled pregnant persons with (PHIV) and without HIV in Cape Town, South Africa who were ≥18 years old at 24-28 weeks gestation and followed them up to 32 months postpartum. We estimated associations between HIV status and cardiometabolic risk including body mass index (BMI), obesity (BMI ≥ 30 kg/m2), blood pressure (BP, elevated systolic BP ≥130 and/or diastolic ≥85 mmHg; ), lipid levels, and metabolic syndrome according to the Joint Interim Statement criteria using multivariable log binomial or linear regression models. Sub-group analyses compared PHIV on efavirenz (EFV)- versus dolutegravir (DTG)-based ART. Results Among 400 participants (n = 200 without HIV, n = 200 PHIV), 52% had pre-pregnancy obesity and 9% elevated BP. By postpartum, 57% were classified with obesity, 31% had elevated BP, and 29% had metabolic syndrome. In multivariable analyses, HIV was associated with a lower BMI pre-pregnancy but not postpartum; however, mean indices were in the obese range regardless of HIV status. Neither BMI nor obesity pre-pregnancy or postpartum differed by ART regimen. Among PHIV, participants on DTG had higher levels of elevated BP in pregnancy and postpartum, compared to PHIV on EFV. Conclusions We observed high levels of obesity, elevated BP, and metabolic syndrome in the perinatal period but few differences by HIV status. Participants on DTG may be more likely to have elevated BP in pregnancy and postpartum. Monitoring of cardiometabolic health for pregnant persons on DTG is warranted.