The following is a summary of “Association of pro-inflammatory fatty acid signatures with adverse pregnancy outcomes in pregnant persons living with human immunodeficiency virus,” published in the FEBRUARY 2023 issue of Obstetrics and Gynecology by Fisher S, et al.

A ratio of less than 6:1 is advised for healthy individuals. Excessive omega-6 to omega-3 (n-6:n-3) polyunsaturated fatty acid (PUFA) ratios harm human health. For a study, researchers sought to investigate the relationship between polyunsaturated fatty acid (PUFA) signatures and adverse pregnancy outcomes (APOs) in pregnant individuals living with HIV (PLHIV).

In the Nutrition Sub-study of the Surveillance Monitoring for ART Toxicities (SMARTT) Pediatric HIV/AIDS Cohort Study, we included pregnant PLHIV enrolled from 2009 to 2011. Using esterification and gas chromatography, we calculated the percentage of the total fatty acid content of pro-inflammatory n-6 and anti-inflammatory n-3 PUFA concentrations in third-trimester plasma. Preterm birth (PTB, <37 weeks’ gestation), preeclampsia, and small-for-gestational-age (SGA, <10th percentile) APOs were compared between individuals with and without the following PUFA ratios (n-6:n-3), which were used to measure inflammatory signatures.

Of 264 eligible pregnant PLHIV, 69% were Black, 69% had antiretroviral medication (ART) before becoming pregnant, and 84% had protease inhibitor-based ART. 12% of pregnant women had CD4 counts <200 cells/mm3, and 56% had HIV viral loads ≥400 copies/mL. PTB, preeclampsia, and SGA rates were 17%, 5%, and 9%, respectively. 

Preeclampsia and PTB had higher median n-6:n-3 ratios than PLHIV without these APOs (13.8 vs 12.9; P=0.02) and (14.6 vs 13.0; P=0.04), respectively. Nevertheless, SGA was associated with lower median n-6:n-3 ratios than non-SGA (11.7 vs 13.2; P=0.03).

Higher n-6:n-3 ratios were associated with PTB and preeclampsia, whereas a lower ratio was associated with SGA in pregnant PLHIV within this cohort. Although n-6:n-3 ratios were generally elevated, these findings suggest that a pro-inflammatory ratio of PUFA may contribute to certain APOs in PLHIV.