Abstract
BackgroundThe risk of cardiovascular diseases (CVDs) is becoming more prevalent in pregnant women though not much data is available for pregnant women with human immunodeficiency virus (HIV). Foetoplacental vascular endothelial dysfunction is thought to be at the origin of chronic diseases such as diabetes and obesity later on in life. Because HIV and anti-retroviral treatment (ARTs) are associated with endothelial dysfunction, children exposed in utero to these conditions may be at greater risk of developing CVDs. Despite the high prevalence of HIV in pregnant South African women, little is known about the effects of ART on the cardiovascular health of the mother and offspring. Hence, the proposed study intends to investigate how HIV/ARTs may affect the cardiovascular health of the mother and offspring at different time points during the pregnancy and up to 2 years after birth.MethodsA longitudinal case–control study in HIV positive pregnant women on ART and HIV negative pregnant women will be conducted. All pregnant women will be assessed for cardio-metabolic risk factors and markers (lipids, anthropometric and glycaemic indies, oxidative stress), hemodynamic status (blood pressure parameters) and vascular function (arterial compliance, retinal microvasculature, uterine artery mean pulsatility index). Child health will be monitored in utero and postnatally via routine foetal health screening, placental integrity, anthropometry, blood pressure parameters, markers of oxidative stress and endothelial function in cord blood and cardiovascular epigenetic markers in urine.DiscussionThere is a paucity of studies in South Africa and sub-Sahara Africa as a whole that utilised a longitudinal study model to assess the effects of ARTs on vascular endothelial changes in pregnant women living with HIV and the cardiometabolic health of their offspring. This study will therefore help to monitor changes in cardiometabolic risk during pregnancy and in children exposed in utero to HIV-infection and ART use. Findings from this study will provide useful information for developing guidelines on the use of ARTs in pregnancy and management of cardiometabolic health of the offspring of HIV positive mothers.
Highlights
The risk of cardiovascular diseases (CVDs) is becoming more prevalent in pregnant women though not much data is available for pregnant women with human immunodeficiency virus (HIV)
Aim and objectives The aim of this study is to investigate whether HIV-infection and anti-retroviral treatments (ARTs) are associated with risk of cardiometabolic diseases in pregnant women of African ancestry and their offspring after birth
A confidence interval of 95% will be taken and α = 0.05 will be considered for level of significance. This ARTMOMSBABES study intends to investigate whether HIV-infected pregnant women on ART have a higher risk for cardiometabolic conditions and whether their offspring are borne with an increased risk for similar conditions
Summary
The risk of cardiovascular diseases (CVDs) is becoming more prevalent in pregnant women though not much data is available for pregnant women with human immunodeficiency virus (HIV). The prevalence of some of these risk factors is very high in the general South African population: obesity (20–25%), hypertension (10.2%), dyslipidemia (24%) and insulin resistance (10–20.7%) [3] explaining why CVDs may contribute significantly to death rates in South Africa [4]. Vascular abnormalities such as arteriolar-venular nicking and increased carotid intima–media thickness, and focal and generalized arteriolar narrowing in adults have been associated with CVDs [5, 6]. Both of these changes in the retinal microvascular are indicative of endothelial dysfunction, a major cardiovascular risk factor
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