Associations between Maternal Lipid Profiles and Pregnancy Complications: A Prospective Population-Based Study

Yiqi Zhang; Xi Lan; Congjie Cai; Run Li; Yan Gao; Liuqing Yang; Cheng Wu; Hongli Dong; Xinxin Pang; Dan Bai; Guo Zeng

doi:10.1055/s-0039-3402724

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2021; 38(08): 834-840
DOI: 10.1055/s-0039-3402724

Original Article

Associations between Maternal Lipid Profiles and Pregnancy Complications: A Prospective Population-Based Study

Yiqi Zhang

¹Department of Nutrition, Food Safety and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China

,

Xi Lan

¹Department of Nutrition, Food Safety and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China

,

Congjie Cai

¹Department of Nutrition, Food Safety and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China

,

Run Li

²Department of Clinical Nutrition, Sichuan Provincial Hospital for Women and Children, Chengdu, Sichuan, China

,

Yan Gao

³Department of Obstetrics, Sichuan Provincial Hospital for Women and Children, Chengdu, Sichuan, China

,

Liuqing Yang

¹Department of Nutrition, Food Safety and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China

,

Cheng Wu

¹Department of Nutrition, Food Safety and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China

,

Hongli Dong

¹Department of Nutrition, Food Safety and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China

,

Xinxin Pang

¹Department of Nutrition, Food Safety and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China

,

Dan Bai

¹Department of Nutrition, Food Safety and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China

,

Guo Zeng

¹Department of Nutrition, Food Safety and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China

› Institutsangaben

Abstract

Objective To investigate whether plasma lipid profiles are independently associated with pregnancy complications including gestational diabetes mellitus (GDM), hypertensive disorder complicating pregnancy (HDCP), and intrahepatic cholestasis of pregnancy (ICP).

Study Design A prospective study was conducted among 1,704 pregnant women at three medical institutions in Chengdu, China. The concentrations of triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured at gestational weeks 12 ± 1, 24 ± 1, and 34 ± 1. Logistic regression models were used to estimate the association between lipid profiles and pregnancy complications. Receiver operating characteristic analysis was performed to determine the value of lipid profiles to predict GDM and HDCP.

Results After adjusting for potential confounders, TG, TC, and LDL-C in the first trimester were independently associated with GDM (TG: odds ratio [OR] =2.00, 95% confidence interval [CI]: 1.57–2.56; TC: OR = 1.38, 95% CI: 1.16–1.64; LDL-C: OR = 1.43, 95% CI: 1.14–1.79) and HDCP (TG: OR = 2.42, 95% CI: 1.56–3.78, TC: OR = 1.64, 95% CI: 1.04–2.57; LDL-C: OR = 1.87, 95% CI: 1.07–3.25). The TC concentration during the whole pregnancy (first trimester: OR = 1.53, 95% CI: 1.13–2.08; second trimester: OR = 1.31, 95% CI: 1.06–1.61; third trimester: OR = 1.39, 95% CI: 1.17–2.04) and LDL-C in the last two trimesters (second trimester: OR = 1.62, 95% CI: 1.30–2.04; third trimester: OR = 1.56, 95% CI: 1.29–1.88) were positively associated with ICP. HDL-C in the third trimester was negatively associated with the risk of ICP (OR = 0.46, 95% CI: 0.22–0.98). Combining lipid profiles in the first trimester with the other common predictors to predict GDM or HDCP owned stronger predictive power with the largest area under the curve (GDM: 0.643 [95% CI: 0.613–0.673], HDCP: 0.707 [95% CI: 0.610–0.804]) than either indicator alone.

Conclusion Maternal lipid profiles during the whole pregnancy are significantly associated with GDM, HDCP, and ICP. Combining lipid profiles in the first trimester with the other common predictors could effectively improve the power of predicting GDM and HDCP.

Keywords

lipid profile - gestational diabetes mellitus - hypertensive disorder complicating pregnancy - intrahepatic cholestasis of pregnancy

Volltext

Referenzen

References
1 Ghio A, Bertolotto A, Resi V, Volpe L, Di Cianni G. Triglyceride metabolism in pregnancy. Adv Clin Chem 2011; 55: 133-153
2 Husain F, Latif S, Uddin M, Nessa A. Lipid profile changes in second trimester of pregnancy. Mymensingh Med J 2008; 17 (01) 17-21
3 Wiznitzer A, Mayer A, Novack V. et al. Association of lipid levels during gestation with preeclampsia and gestational diabetes mellitus: a population-based study. Am J Obstet Gynecol 2009; 201 (05) 482.e1-482.e8
4 Jin WY, Lin SL, Hou RL. et al. Associations between maternal lipid profile and pregnancy complications and perinatal outcomes: a population-based study from China. BMC Pregnancy Childbirth 2016; 16 (01) 60
5 Lee KW, Ching SM, Ramachandran V. et al. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2018; 18 (01) 494
6 Motedayen M, Rafiei M, Rezaei Tavirani M, Sayehmiri K, Dousti M. The relationship between body mass index and preeclampsia: a systematic review and meta-analysis. Int J Reprod Biomed (Yazd) 2019; 17 (07) 463-472
7 Chen J, Li Q, Ma J. Maternal serum, placental, and umbilical venous blood irisin levels in intrahepatic cholestasis of pregnancy. J Matern Fetal Neonatal Med 2019; 1-8
8 Shen H, Liu X, Chen Y, He B, Cheng W. Associations of lipid levels during gestation with hypertensive disorders of pregnancy and gestational diabetes mellitus: a prospective longitudinal cohort study. BMJ Open 2016; 6 (12) e013509
9 Ryckman KK, Spracklen CN, Smith CJ, Robinson JG, Saftlas AF. Maternal lipid levels during pregnancy and gestational diabetes: a systematic review and meta-analysis. BJOG 2015; 122 (05) 643-651
10 Montelongo A, Lasunción MA, Pallardo LF, Herrera E. Longitudinal study of plasma lipoproteins and hormones during pregnancy in normal and diabetic women. Diabetes 1992; 41 (12) 1651-1659
11 Adank MC, Benschop L, Peterbroers KR. et al. Is maternal lipid profile in early pregnancy associated with pregnancy complications and blood pressure in pregnancy and long term postpartum?. Am J Obstet Gynecol 2019; 221 (02) 150.e1-150.e13
12 Sattar N, Bendomir A, Berry C, Shepherd J, Greer IA, Packard CJ. Lipoprotein subfraction concentrations in preeclampsia: pathogenic parallels to atherosclerosis. Obstet Gynecol 1997; 89 (03) 403-408
13 Sattar N, Gaw A, Packard CJ, Greer IA. Potential pathogenic roles of aberrant lipoprotein and fatty acid metabolism in pre-eclampsia. Br J Obstet Gynaecol 1996; 103 (07) 614-620
14 Zhang C, Austin MA, Edwards KL. et al. Functional variants of the lipoprotein lipase gene and the risk of preeclampsia among non-Hispanic Caucasian women. Clin Genet 2006; 69 (01) 33-39
15 de Arcos F, Castelo-Branco C, Casals E, Sanllehy C, Cararach V. Normal and gestational diabetic pregnancies. Lipids, lipoproteins and apolipoproteins. J Reprod Med 1998; 43 (02) 144-148
16 Vitoratos N, Kassanos D, Salamalekis E, Siristatidis Ch, Baimacou E, Creatsas G. Maternal homocysteine levels and plasma lipids in gestational diabetes: is there any relationship?. J Obstet Gynaecol 2002; 22 (04) 366-369
17 Başaranoğlu S, Ağaçayak E, Uçmak F. et al. The role of vitamin B1-B2 and plasma lipid profile in intrahepatic cholestasis of pregnancy. J Perinat Med 2017; 45 (04) 461-465
18 Li YJ, Liu HY, Han WH. et al. Incidence and characteristics of intrahepatic cholestasis of pregnancy in 4 081 hospitalized pregnant women. Fudan University Journal of Medical Science 2018; 45 (04) 490-495
19 Dann AT, Kenyon AP, Wierzbicki AS, Seed PT, Shennan AH, Tribe RM. Plasma lipid profiles of women with intrahepatic cholestasis of pregnancy. Obstet Gynecol 2006; 107 (01) 106-114
20 Martineau MG, Raker C, Dixon PH. et al. The metabolic profile of intrahepatic cholestasis of pregnancy is associated with impaired glucose tolerance, dyslipidemia, and increased fetal growth. Diabetes Care 2015; 38 (02) 243-248
21 Fiorucci S, Mencarelli A, Palladino G, Cipriani S. Bile-acid-activated receptors: targeting TGR5 and farnesoid-X-receptor in lipid and glucose disorders. Trends Pharmacol Sci 2009; 30 (11) 570-580
22 Sharma R, Long A, Gilmer JF. Advances in bile acid medicinal chemistry. Curr Med Chem 2011; 18 (26) 4029-4052
23 Glantz A, Reilly SJ, Benthin L, Lammert F, Mattsson LA, Marschall HU. Intrahepatic cholestasis of pregnancy: amelioration of pruritus by UDCA is associated with decreased progesterone disulphates in urine. Hepatology 2008; 47 (02) 544-551
24 Abu-Hayyeh S, Papacleovoulou G, Lövgren-Sandblom A. et al. Intrahepatic cholestasis of pregnancy levels of sulfated progesterone metabolites inhibit farnesoid X receptor resulting in a cholestatic phenotype. Hepatology 2013; 57 (02) 716-726
25 Chasan-Taber L, Schmidt MD, Roberts DE, Hosmer D, Markenson G, Freedson PS. Development and validation of a Pregnancy Physical Activity Questionnaire. Med Sci Sports Exerc 2004; 36 (10) 1750-1760
26 Metzger BE, Gabbe SG, Persson B. et al; International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33 (03) 676-682
27 Eiland E, Nzerue C, Faulkner M. Preeclampsia 2012. J Pregnancy 2012; 2012: 586578
28 Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol 2014; 124 (01) 120-133
29 Chandi A, Sirohiwal D. Role of serum triglyceride levels in predicting hypertensive disorders of pregnancy. BJOG 2014; 121: 158-159
30 Yue CY, Ying CM. Epidemiological analysis of maternal lipid levels during the second trimester in pregnancy and the risk of adverse pregnancy outcome adjusted by pregnancy BMI. J Clin Lab Anal 2018; 32 (08) e22568
31 Wu L, Ma D, Walton-Moss B, He Z. Effects of low-fat diet on serum lipids in premenopausal and postmenopausal women: a meta-analysis of randomized controlled trials. Menopause 2014; 21 (01) 89-99
32 Srivastava RA, Srivastava N, Averna M. Dietary cholic acid lowers plasma levels of mouse and human apolipoprotein A-I primarily via a transcriptional mechanism. Eur J Biochem 2000; 267 (13) 4272-4280
33 Claudel T, Sturm E, Duez H. et al. Bile acid-activated nuclear receptor FXR suppresses apolipoprotein A-I transcription via a negative FXR response element. J Clin Invest 2002; 109 (07) 961-971
34 Dann AT, Kenyon AP, Seed PT, Poston L, Shennan AH, Tribe RM. Glutathione S-transferase and liver function in intrahepatic cholestasis of pregnancy and pruritus gravidarum. Hepatology 2004; 40 (06) 1406-1414