Pregnancy-associated Hypertriglyceridemia in Normal and Diabetic Women: Differences in Insulin-dependent, Non-insulin-dependent, and Gestational Diabetes

Abstract

In this study longitudinal observations of plasma lipoproteins were made in pregnant diabetic women classified according to the National Diabetes Data Group. Sequential measurements at second trimester (25-27 wk), third trimester (34-37 wk), and 3 mo postpartum (control period) were carried out in 18 diabetic and 6 normal women. In 15 diabetic and 4 normal women from this group, 24-h plasma glucose, serum C-peptide levels, and HbA 1c concentrations were measured. Another group of 15 normal and 18 diabetic women underwent determinations of fasting plasma lipoproteins and other parameters at one or more of the test periods.Insulin-dependent diabetic patients (IDDM, type I) as a group did not differ from normal controls in mean plasma levels of total cholesterol (CHOL), triglyceride (TG), very-low-density lipoprotein triglyceride (VLDL TG), low-density lipoprotein cholesterol (LDL CHOL), high-density lipoprotein cholesterol (HDL CHOL), or ratios of TG:CHOL in LDL or HDL during mid or late pregnancy or 3 mo postpartum. In marked contrast, non-insulin-dependent diabetics (NIDDM, type II) had significantly higher total fasting TG at second trimester (P < 0.005), third trimester (P < 0.03), and postpartum (P < 0.01). VLDL TG levels at the second trimester, third trimester, and postpartum also were higher than in women with IDDM or normals. In NIDDM subjects the accentuated hypertriglyceridemia during second and third trimesters was also apparent in elevated LDL TG:CHOL and HDL TG:CHOL ratios. These differences were not correlated with prepregnancy weight, weight gain during gestation, or diabetic control. Women with gestational diabetes (GDM) also had significantly higher TG levels at second trimester and postpartum. Mean HDL CHOL levels were significantly lower in patients with NIDDM and GDM than in controls and IDDM patients throughout pregnancy and 3 mo postpartum. two of 21 normals and one woman with IDDM diabetes had spontaneously reversible pregnancy-evoked hypertriglyceridemia.These results indicate that women with IDDM diabetes do not differ from normal women with respect to pregnancy-associated changes in lipid metabolism. On the other hand, women with NIDDM and GDM exhibit a pregnancy-associated hypertriglyceridemia.

Changes in plasma lipids and markers of oxidative stress in normal pregnancy and pregnancies complicated by diabetes

“…On the contrary, women with diabetes show a gradual increase in total cholesterol and triacylglycerol concentrations during pregnancy, but the changes were not significantly different from those observed in normal pregnancy, suggesting that they are independent of diabetic status and are simply a manifestation of pregnancy. This is in agreement with the findings of Hollingsworth and Grundy [25], who showed that normal pregnant women and those with Type I diabetes have no significant differences in cholesterol, triacylglycerols or any lipoprotein subfraction. Similarly, Montelongo et al [26] demonstrated progressive increases in plasma triacylglycerol and cholesterol levels with gestational age, but failed to show differences between normal women and those with Type I diabetes.…”

Lipoprotein Metabolism in Pregnancy, Fat Transport to the Fetus, and the Effects of Diabetes

“…As mentioned earlier, exaggerated hypertriglyc eridemia seems to be a feature of gestational [52][53][54] and overt type II diabetes in preg nancy [30,53,54] and HDL cholesterol tends to be reduced in those conditions [53,54], Examples of VLDL triglyceride and HDL cholesterol changes in type II diabetic pregnancy are presented in figure 12, show ing that levels can be abnormal in diabetic pregnancy and return to normal postpartum [53], Previous reports of type I diabetes in pregnancy [53,54], involving limited num bers of subjects, suggested that HDL choles-tcrol was increased in type I diabetes in preg nancy as it is in nonpregnant type I diabetic subjects [for review, see 55]. However, a re cent analysis by Van Allen et al [56] of a larger number of pregnant type 1 diabetics followed throughout gestation indicates that cholesterol in HDL and HDLi are both re duced throughout gestation.…”

Implication of lipids in macrosomia of diabetic pregnancy: can n-3 polyunsaturated fatty acids exert beneficial effects?

“…Type I diabetic mothers with poor glycaemic control had increased serum TAGs, apoB100 and VLDL-TAG [4,32]. Type II diabetics had significantly higher TAG levels in all lipoprotein fractions than women with Type I diabetes or normal subjects [41]. Infants of diabetic mothers also showed lipoprotein changes.…”