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The objective of this study is to examine associations between lipids (high-density lipoprotein, low-density lipoprotein, total cholesterol, triglycerides and lipoprotein (a)) measured on average three time points during pregnancy and neonatal anthropometrics.Stored samples from a preeclampsia trial measured as part of a case-control study from five US centers (1992 to 1995) were used. The sample included women without pregnancy complications (n = 136) and cases of gestational diabetes (n = 93), abnormal glucose tolerance (AGT; n = 76), gestational hypertension (n = 170) and preeclampsia (n = 177). Linear regression and linear mixed-effects models estimated adjusted associations between lipids and birth weight z-score, ponderal index (PI), length and head circumference.Among women without complications, cross-sectional associations between total cholesterol measured at different gestational ages increased PI 2.23 to 2.55 kg m-3 per-unit increase in cholesterol. HDL was inversely associated with birth length (β’s = - 2.21 and - 2.56 cm). For gestational hypertension, triglycerides were associated with birth weight z-score (β’s = 0.24 to 0.31). For preeclampsia, HDL was associated with lower birth weight z-scores (β’s = - 0.49 and - 0.82). Women with gestational diabetes or AGT had inconsistent associations. Examining the level changes across pregnancy, each 0.0037 mmol l-1 increase in HDL was associated with decreased birth weight z-score (β = - 0.22), length (β = - 0.24 cm) and head circumference (β = - 0.24 cm), whereas each 0.028 mmol l-1 increase in triglycerides was associated with increased birth weight z-score (β = 0.13) and head circumference (β = 0.19 cm).Although associations varied by complications, in general, growth-promoting fuels such as total cholesterol and triglycerides were associated with increased neonatal size, whereas high HDL was associated with smaller size. Maternal HDL that failed to decrease over pregnancy was associated with smaller neonate size.