Markers of Maternal Insulin Resistance and Lipid Ratios Measured in Early Pregnancy Are Related to Adverse Fetomaternal Outcomes in Women Treated for Hyperglycemia Detected in Early Pregnancy—Data from a Retrospective Cohort Study

Zawiejska, Agnieszka; Wróblewska-Seniuk, Katarzyna; Kippen, Joanna; Gomulska, Anna; Wender-Ożegowska, Ewa

doi:10.3390/jcm11071777

Cited by 6 publications

(5 citation statements)

References 42 publications

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“…Hypertriglyceridemia is an outstanding reflection of insulin resistance. It is an essential criterion for diagnosing metabolic syndrome (29) and both of which are known to be associated with adverse pregnancy outcomes, such as hypertensive disorders of pregnancy (12,16,30), preterm labor (13) and LGA (12,13,16,31); and with long-term risk for cardiovascular disease (32,33). The relationship between elevated TG levels and increased risk of IR has been clearly stated in non-pregnant individuals (29,34,35).…”

Section: Discussionmentioning

confidence: 99%

Longitudinal trends in lipid profiles during pregnancy: Association with gestational diabetes mellitus and longitudinal trends in insulin indices

et al. 2023

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ObjectiveTo investigate the correlation of trends in lipid profiles from first to second trimester with trends in insulin indices and gestational diabetes mellitus (GDM).MethodsSecondary analysis of an ongoing prospective cohort study was conducted on 1234 pregnant women in a single center. Lipid profiles, glucose metabolism and insulin indices were collected in the first and second trimesters. Trends in lipid profiles were divided into four subgroups: low-to-low, high-to-high, high-to-low and low-to-high group. Insulin indices including homeostasis model assessment of insulin resistance and quantitative insulin sensitivity check index were calculated to evaluate insulin resistance (IR). Trends in insulin indices were described as: no IR, persistent IR, first-trimester IR alone and second-trimester IR alone. Pearson correlation analysis and multivariate logistic regression were performed to assess the associations of lipid profiles subgroups with insulin indices and GDM.ResultsFirst- and second-trimester total cholesterol (TC), triglycerides (TG) and high-density lipoprotein cholesterol were strongly correlated to first- and second-trimester insulin indices. Only TG had a sustained correlation with glucose metabolism indices. High-to-high low-density lipoprotein cholesterol (LDL-c) was an independent risk factor for GDM. High-to-high TG and high-to-low TG groups were independent risk factors for persistent IR. High-to-high TG and low-to-high TG groups were independent risk factors for second-trimester IR alone.ConclusionTG has a sustained correlation with insulin indices and glucose metabolism indices. Persistently high TG is an independent risk factor for persistent IR and second-trimester IR alone. Regardless of whether pregnant women have first-trimester IR, lower TG levels help reduce the risk for persistent IR or subsequent development of IR. These results highlight the benefit of lowering TG levels in early and middle pregnancy to prevent the development of IR.

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Section: Discussionmentioning

confidence: 99%

Longitudinal trends in lipid profiles during pregnancy: Association with gestational diabetes mellitus and longitudinal trends in insulin indices

et al. 2023

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“…However, a screening of pregnant women for maternal hyperglycemia showed a spectrum of glucose intolerance 3 . Studies have investigated the association of fasting plasma glucose, hemoglobin A1c (HbA1c), oral glucose tolerance, and insulin resistance with adverse obstetric outcomes 4 , 5 , 6 . Nevertheless, debate exists on the relationship of perinatal outcomes with glycemic levels in early pregnancy 1 , 5 , 7 , 8 .…”

Section: Introductionmentioning

confidence: 99%

“…Studies have investigated the association of fasting plasma glucose, hemoglobin A1c (HbA1c), oral glucose tolerance, and insulin resistance with adverse obstetric outcomes 4 , 5 , 6 . Nevertheless, debate exists on the relationship of perinatal outcomes with glycemic levels in early pregnancy 1 , 5 , 7 , 8 . In particular, the association of maternal blood glucose concentrations with the risk of adverse pregnancy outcomes (APO) in women without gestational diabetes mellitus remains controversial 9 , 10 .…”

Section: Introductionmentioning

confidence: 99%

Post‐load glucose is a stronger predictor of adverse pregnancy outcomes than first‐trimester HbA1c in women without gestational diabetes

Rajabi,

Toghraee,

Nejatipour

2024

J of Diabetes Invest

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Aims/IntroductionA debate exists on the relation of adverse pregnancy outcomes with glycemic levels in early pregnancy. We aimed to investigate the association of maternal characteristics including post‐load glucose and first‐trimester HbA1c test results with adverse pregnancy outcomes in women without gestational diabetes mellitus.Materials and MethodsA dataset (January 2011 and September 2017) from a hospital prenatal clinic was explored to find the important predictors of adverse pregnancy outcomes using maternal characteristics and glucose assessments in mothers without gestational diabetes. We used two machine learning algorithms to capture nonlinearity in selecting important maternal characteristics and developed predictive models for each outcome. In total, 1,618 pregnant women were included in the analytic dataset with a mean (SD) age of 26.8 (3.5) years and gravida of 1.7 (0.9).ResultsImportant associations were detected between maternal features and primary cesarean section, fetal distress, premature rupture of membranes, macrosomia, small or large for gestational age, APGAR <7 at 1 or 5 min, hyperbilirubinemia, and poly‐ or oligo‐hydramnios. Overall, the predictive models showed good performance and large areas under the curves (0.732, 0.765, 0.646, 0.651, 0.730, 0.646, 0.684, 0.716, and 0.678, respectively). Specifically, they had high positive likelihood ratios.ConclusionsHigh glucose levels were associated with adverse pregnancy outcomes. Post‐load glucose was the most reliable test for predicting the outcomes. Overall, fasting blood sugar was of more predictive value than HbA1c. Our study showed that further research should account for the nonlinearity and interactions inherent in the data.

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“…Therefore, exploring the link between maternal lipid metabolism and NH is crucial. Previous research has mainly focused on exploring the effects of maternal blood lipid indicators on SGA, LGA, macrosomia and other adverse pregnancy outcomes [22][23][24], and studies which have investigated the connection between maternal blood lipids and NH are in a minority [25,26]. Consequently, this study included blood lipid indicators from GDM women in order to provide more evidence for the correlation between maternal blood lipids and the risk of NH in infants born to mothers with GDM.…”

Section: Introductionmentioning

confidence: 99%

Association between maternal blood lipids and neonatal hypoglycaemia in pregnancy with gestational diabetes mellitus: a cohort study

Zhang,

Huang,

Lin

et al. 2024

Lipids Health Dis

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Background Gestational diabetes mellitus (GDM) prevalence is on the rise globally. Offspring of diabetic mothers face increased risk of neonatal hypoglycaemia (NH), and women with GDM have abnormal lipid profiles. However, there is no consensus on the link between maternal blood lipids and NH in infants from mothers with GDM. This study aimed to explore how maternal blood lipids affect NH. Methods A retrospective cohort study was conducted at the First Affiliated Hospital of Sun Yat-sen University. Information on participants’ baseline characteristics and maternal metabolic profiles of glucose and lipids was collected. Significant variables from the univariate analysis were included in logistic regression, which was used to construct the predictive model for NH. A nomogram was constructed for visualizing the model and assessed using the area under the receiver operating characteristic (ROC) curve (AUC). Results Neonatal capillary blood glucose (CBG) decreased rapidly in the first hour after birth, increased gradually from the first to the second hour, and then remained stable. In the NH group, 86.11% (502/583) of hypoglycaemia cases occurred within the first two hours after birth. Multivariate logistic regression suggested that the lipid indices of maternal apoprotein B/apoprotein A1 (Apo-B/Apo-A1) (odds ratio (OR) = 1.36, 95% confidence intervals (CIs): 1.049–1.764, P = 0.02) and apoprotein E (Apo-E) (OR = 1.014, 95% CIs: 1.004–1.024, P = 0.004) were positively associated with NH in neonates from mothers with GDM. Triglycerides (TGs) (OR = 0.883, 95% CIs: 0.788–0.986, P = 0.028) were inversely associated with NH. Maternal glycated haemoglobin (HbA1c), age, twin pregnancy and caesarean delivery also had predictive value of NH. The AUC of the nomogram derived from these factors for the prediction model of NH was 0.657 (95% CIs: 0.630–0.684). Conclusions The present study revealed that the Apo-B/Apo-A1 and Apo-E levels were associated with an increased risk of NH. A nomogram was developed to forecast the risk of NH in babies born to mothers with GDM, incorporating maternal blood lipids, HbA1c, age, twin pregnancy, and caesarean section. The trajectory of glycaemia for neonates indicates the need for intensive CBG monitoring within 2 h of birth for neonates from mothers with GDM.

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Markers of Maternal Insulin Resistance and Lipid Ratios Measured in Early Pregnancy Are Related to Adverse Fetomaternal Outcomes in Women Treated for Hyperglycemia Detected in Early Pregnancy—Data from a Retrospective Cohort Study

Cited by 6 publications

References 42 publications

Longitudinal trends in lipid profiles during pregnancy: Association with gestational diabetes mellitus and longitudinal trends in insulin indices

Longitudinal trends in lipid profiles during pregnancy: Association with gestational diabetes mellitus and longitudinal trends in insulin indices

Post‐load glucose is a stronger predictor of adverse pregnancy outcomes than first‐trimester HbA1c in women without gestational diabetes

Association between maternal blood lipids and neonatal hypoglycaemia in pregnancy with gestational diabetes mellitus: a cohort study

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