Associations of lipid levels during gestation with hypertensive disorders of pregnancy and gestational diabetes mellitus: a prospective longitudinal cohort study

Abstract

ObjectiveTo assess associations of elevated lipid levels during gestation with hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM).MethodsThis prospective cohort study was conducted in a tertiary maternal hospital in Shanghai, China from February to November 2014. Lipid constituents, including triglycerides (TGs), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) of 1310 eligible women were assessed in the first (10–13+ weeks), second (22–28 weeks) and third (30–35 weeks) trimesters consecutively. Associations of lipid profiles with HDP and/or GDM outcomes were assessed.ResultsCompared with the normal group, maternal TG concentrations were higher in the HDP/GDM groups across the three trimesters (p<0.001); TC and LDL-c amounts were only higher in the first trimester for the HDP and GDM groups (p<0.05). HDL-c levels were similar in the three groups. Compared with intermediate TG levels (25–75th centile), higher TG amounts (>75th centile) were associated with increased risk of HDP/GDM in each trimester with aORs (95% CI) of 2.04 (1.41 to 2.95), 1.81 (1.25 to 2.63) and 1.78 (1.24 to 2.54), respectively. High TG elevation from the first to third trimesters (>75th centile) was associated with increased risk of HDP, with an aOR of 2.09 (1.16 to 3.78). High TG elevation before 28 weeks was associated with increased risk of GDM, with an aOR of 1.67 (1.10 to 2.54). TG elevation was positively correlated with weight gain during gestation (R=0.089, p=0.005).ConclusionsControlling weight gain during pregnancy could decrease TG elevation and reduce the risk of HDP/GDM. TGs could be used as follow-up parameters during complicated pregnancy, while other lipids are meaningful only in the first trimester.

A prospective cohort study of early‐pregnancy risk factors for gestational diabetes in polycystic ovarian syndrome

“…In addition to dysregulation of glycaemia and blood pressure, maternal lipid disorders during early pregnancy, including total cholesterol, LDL‐c, non‐HDL‐c, and ApoB levels, were positively correlated with GDM. While some studies found no significant association between total and LDL cholesterol with the risk for GDM, our observations confirm the findings of other studies, which demonstrated a strong link between cholesterol levels during early gestation and GDM . ApoB is an essential component of LDL particles, and its increase during pregnancy is parallel to the increase in LDL‐c .…”

“…While some studies found no significant association between total and LDL cholesterol with the risk for GDM, 27,28 our observations confirm the findings of other studies, which demonstrated a strong link between cholesterol levels during early gestation and GDM. 29,30 ApoB is an essential component of LDL particles, and its increase during pregnancy is parallel to the increase in LDL-c. 31 Our study identified a significant positive relationship between ApoB level and GDM in PCOS women. In contrast, no significant association was found between ApoB during early gestation and GDM in non-PCOS women.…”

Thyroid autoantibodies in pregnancy are associated with hypertensive disorders of pregnancy: Ma'anshan Birth Cohort Study

“…In China, HDP occur in 4%-11% of pregnant women. [2][3][4] HDP have been associated with adverse health outcomes for both mothers and children, including subsequent hypertension and chronic kidney disease for mothers, 5,6 childhood overweight/obesity, type 2 diabetes and attention deficit/hyperactivity disorder (ADHD). [7][8][9] Therefore, it is important to identify the risk factors associated with HDP during pregnancy.…”

Previous Gestational Diabetes Increases Atherogenic Dyslipidemia in Subsequent Pregnancy and Postpartum

“…On the other hand, several studies suggested that lipid patterns may identify women at risk of developing GDM (Dos Santos‐Weiss, Rea, & Fadel‐Picheth, ; Enquobahrie, Williams, Qiu, & Luthy, ; Ryckman et al, ; Shen, Liu, Chen, He, & Cheng, ; Wang et al, ). In a prospective longitudinal cohort study of 1300 Chinese women, Shen et al () reported that hypertriglyceridemia during gestation was a risk factor for GDM and hypertensive disorders of pregnancy. Also in a Chinese population, another study with 934 nondiabetic women showed maternal hypertriglyceridemia in late pregnancy to be independently associated with increased risk of GDM, preeclampsia, and macrosomia (Jin et al, ).…”

“…However, studies assessing the association between early‐pregnancy lipid profiles and GDM risk are limited and inconsistent (Dos Santos‐Weiss et al, ; Enquobahrie et al, ; Shen et al, ; Wang et al, ). It is unclear whether hyperlipidemia and mainly hypertriglyceridemia occur exclusively later in pregnancy after the manifestation of GDM or whether they existed before insulin resistance.…”