Mediating Effects of Maternal Blood Triglycerides on the Relationship between Prepregnancy Body Mass Index and Fetal Macrosomia

Lu, Sha; Fu, Yuanqing; Wu, Yingying; Mao, Ai-fen; Xu, Mengyan; Zheng, Gen; Cai, Feng-cheng; Wang, Xuhong; Shi, Mei-qi; Hu, Wensheng

doi:10.1016/j.jpeds.2020.07.011

“…It is suggested that high expression of D-dimer, total bile acids, and glycolic acid may be associated with hypertensive disorder complicating pregnancy maternal lipid energy and the development and progression of dyslipidemia. Close monitoring of serum D-dimer, total bile acids, glycolic acid, and lipid levels in pregnant women with hypertensive disorder complicating pregnancy in clinical practice may be important to ensure good pregnancy outcome and achieve eugenics [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

A Meta-Analysis of the Differences in Serum Lipid Levels between Pregnant Women with Hypertensive Disorder Complicating Pregnancy and Nonhypertensive Disorder Complicating Pregnancy

Zhang

¹

,

Pei

²

,

Li

³

2022

BioMed Research International

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Background. Although a lot of research work has been done on the etiology and pathogenesis of hypertensive disorder complicating pregnancy at home and abroad, the exact etiology and pathogenesis of the disease are still uncertain so far. Aims. Systematic review of meta-analysis of differences in serum lipid levels between pregnant women with hypertensive disease complicated with pregnancy and nonhypertensive disease complicated with pregnancy. Materials and Methods. PubMed, Medline, Embase, Science Citation Index (SCI), Cochrane, Springer, CNKI, Wanfang, VIP, and other databases were used to retrieve published literature and evaluate the included literature according to the quality evaluation method of medical literature introduced by the Cochrane Collaboration. A systematic review of the included studies was performed by meta-analysis. Results. We included 9 articles that documented total bile acids and D-dimers. In the heterogeneity test ( P < 0.05 , I 2 = 100 % > 50 % ), it was considered that the study was heterogeneous, so sensitivity analysis was used, the fixed-effect model was replaced, and the results were not significantly different after each item was excluded. Reliably, the difference was statistically significant ( Z = 7.32 , P < 0.001 ). In the TG metaheterogeneity test, P < 0.05 , I 2 = 99 % > 50 % , to explore the source of heterogeneity and conduct sensitivity analysis and switch to fixed-effect model, the difference was not statistically significant ( P > 0.05 ). There was no significant difference in TC between hypertensive disorder complicating pregnancy and nonhypertensive disorder complicating pregnancy ( P > 0.001 ). Conclusion. D-dimer, total bile acids, and glycopyrrolate were highly expressed in the sera of pregnant women with hypertensive disorder complicating pregnancy dyslipidemia.

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“…Studies have shown that prepregnancy BMI and fasting serum TG were independently associated with birth weight in normal glucose tolerance mothers [ 40 ]. Lu et al reported that mTG mediates the association of prepregnancy BMI with the risk of fetal macrosomia, which highlights the importance of the role that maternal circulating mTG during pregnancy plays in the development of fetal macrosomia [ 41 ]. Similarly, Song et al found that nondiabetic women who were overweight/obese before pregnancy were at increased risk of developing a giant fetus, and this positive association was mediated in part by high maternal TG levels [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Mediation effect of maternal triglyceride and fasting glucose level on the relationship between maternal overweight/ obesity and fetal growth: a prospective cohort study

Wan

¹

,

Chen

²

,

Wu

³

et al. 2023

BMC Pregnancy Childbirth

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Background Previous studies have suggested that maternal overweight/obesity is asscociated with macrosomia. The present study aimed to investigate the mediation effects of fasting plasma glucose (FPG) and maternal triglyceride (mTG) in the relationship between maternal overweight/obesity and large for gestational age (LGA) among non-diabetes pregnant women. Methods This prospective cohort study was conducted in Shenzhen from 2017 to 2021. A total of 19,104 singleton term non-diabetic pregnancies were enrolled form a birth cohort study. FPG and mTG were measured at 24–28 weeks. We analyzed the association of maternal prepregancy overweight/obesity with LGA and mediation effects of FPG and mTG. Multivariable logistic regression analysis and serial multiple mediation analysis were performed. The odds ratio (OR) and 95% confidence intervals (CIs) were calculated. Results Mothers who were overweight or obese had higher odds of giving birth to LGA after adjusting potential confounders (OR:1.88, 95%CI: 1.60–2.21; OR:2.72, 95%CI: 1.93–3.84, respectively). The serial multiple mediation analysis found prepregnancy overweight can not only have a direct positive effect on LGA (effect = 0.043, 95% CI: 0.028–0.058), but also have an indirect effect on the LGA through two paths: the independent mediating role of FPG (effect = 0.004, 95% CI: 0.002–0.005); the independent mediating role of mTG (effect = 0.003,95% CI: 0.002–0.005). The chain mediating role of FPG and mTG has no indirect effect. The estimated proportions mediated by FPG and mTG were 7.8% and 5.9%. Besides, the prepregnancy obesity also has a direct effect on LGA (effect = 0.076; 95%CI: 0.037–0.118) and an indirect effect on LGA through three paths: the independent mediating role of FPG (effect = 0.006; 95%CI: 0.004–0.009); the independent mediating role of mTG (effect = 0.006; 95%CI: 0.003–0.008), and the chain mediating role of FPG and mTG (effect = 0.001; 95%CI: 0.000-0.001). The estimated proportions were 6.7%, 6.7%, and 1.1%, respectively. Conclusion This study found that in nondiabetic women, maternal overweight/obesity was associated with the occurence of LGA, and this positive association was partly mediated by FPG and mTG, suggesting that FPG and mTG in overweight/obese nondiabetic mothers deserve the attention of clinicians.

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“…Lu and colleagues considered BMI to be a continuous variable and reported that the proportion of high mTG levels mediating the association between pre-pregnancy BMI and macrosomia was approximately 15.7% in all pregnancies [ 22 ]. Obviously, their observations were not comparable to ours, due to differences in the inclusion and exclusion criteria of participants and type of variables, but both suggested a considerable direct role of obesity in microsomia, as well as other, as-yet unknown, mediating roles in the association between maternal obesity and infant birth weight.…”

Section: Discussionmentioning

confidence: 99%

“…High mTG levels are a known consequence of overweight/obesity and risk factor for macrosomia, indicating that high mTG levels may be on this causal pathway. Actually, Lu and colleagues have reported that mTG has a significant mediating effect on the relationship between pre-pregnancy BMI and macrosomia [ 22 ]. Lipid metabolism in normal glucose-tolerant pregnancies differs from that in GDM pregnancies, where a rise of insulin promotes the maternal fat depots and increases the subsequent hypertriglyceridemia, due to insulin resistance and estrogen-like effects [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

High Maternal Triglyceride Levels Mediate the Association between Pre-Pregnancy Overweight/Obesity and Macrosomia among Singleton Term Non-Diabetic Pregnancies: A Prospective Cohort Study in Central China

Song

¹

,

Chen

²

,

Zhang

³

et al. 2022

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This study aimed at examining the risk of macrosomia, in relation to maternal pre-pregnancy overweight/obesity mediated via high maternal triglyceride (mTG) levels. In this prospective study, 24,730 singleton term non-diabetic pregnancies were finally included. Serum mTG levels were measured using fasting blood samples that were collected after 28 weeks of gestation. High mTG levels were defined as values ≥ the 90th percentile. The outcome of interest was macrosomia (≥4000 g). Log-binomial regression was used to assess the mediation path between overweight/obesity, high mTG levels, and macrosomia. The mediation analysis found a total effect of overweight on macrosomia of 0.006 (95% CI, 0.001–0.010), including a direct effect of 0.005 (95% CI, 0.001, 0.009) and indirect effect of 0.001 (95% CI, 0.000–0.001), with an estimated proportion of 11.1% mediated by high mTG levels. Additionally, we also found a total effect of obesity on macrosomia of 0.026 (95% CI, 0.018–0.036), including a direct effect of 0.025 (95% CI, 0.017–0.036) and indirect effect of 0.001 (95% CI, 0.000–0.001), with an estimated proportion of 3.8% mediated by high mTG levels. In conclusion, non-diabetic women with overweight or obesity had an increased risk of macrosomia, and this positive association was partly mediated by high mTG levels.

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Mediating Effects of Maternal Blood Triglycerides on the Relationship between Prepregnancy Body Mass Index and Fetal Macrosomia

Cited by 6 publications

References 24 publications

A Meta-Analysis of the Differences in Serum Lipid Levels between Pregnant Women with Hypertensive Disorder Complicating Pregnancy and Nonhypertensive Disorder Complicating Pregnancy

A Meta-Analysis of the Differences in Serum Lipid Levels between Pregnant Women with Hypertensive Disorder Complicating Pregnancy and Nonhypertensive Disorder Complicating Pregnancy

Mediation effect of maternal triglyceride and fasting glucose level on the relationship between maternal overweight/ obesity and fetal growth: a prospective cohort study

High Maternal Triglyceride Levels Mediate the Association between Pre-Pregnancy Overweight/Obesity and Macrosomia among Singleton Term Non-Diabetic Pregnancies: A Prospective Cohort Study in Central China

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