Pregnancies, live births, and heart structure and function in women with HIV

Objective: Women with HIV (WWH) have up to five times higher risk for cardiovascular disease compared to age-matched women without HIV, and this risk is pronounced in reproductive-aged women. Pregnancy promotes systemic inflammation, leading to remodeling of the heart’s structure and changes in function during and after pregnancy; therefore, we sought to examine the association of pregnancy history and number of live births with changes in cardiac structure and function in women with and without HIV (WWoH). Methods: Cross-sectional data from the Multicenter AIDS Cohort Study/Women’s Interagency HIV Study Combined Cohort Study (MWCCS) were analyzed using univariate and multivariable logistic and linear regression models. Data from participants with echocardiograms conducted during or after their last pregnancy were included. The association between echocardiographic parameters and ever having had a live birth and number of live births was examined by HIV status. Results: Of 1,646 women (1,156 WWH and 490 WWoH), 83% (n = 1,369) had a history of live births. Among WWH, ever having a live birth was associated with decreased left ventricular ejection fraction (β=-1.33, p = 0.014) and number of live births was associated with increased odds of diastolic dysfunction (OR = 1.14, p = 0.009). In WWoH, live births were significantly associated with increased left ventricular end-diastolic volume index (β = 0.64, p = 0.029). Conclusion: In this study, live birth history was associated with small but significant changes in cardiac structure and function, with WWH showing greaterlikelihood of adverse echocardiographic changes. This highlights differential cardiac remodeling patterns by HIV status. Longitudinal studies are needed to assess the progression and clinical implications of these findings.