Abstract
AimsDyslipidemia in pregnancy is associated with adverse pregnancy outcomes as elevated triglycerides might be considered as a risk factor for hyperglycemia and gestational diabetes. As only a few studies have addressed the association between maternal triglycerides and glucose metabolism, we aimed to explore the pathophysiologic associations of moderate hypertriglyceridemia and maternal glucose metabolism in pregnancy.MethodsSixty-seven pregnant women received a detailed metabolic characterization at 12+0–22+6 weeks of gestation by an extended 2h-75g OGTT (oral glucose tolerance test); with measurements of glucose, insulin and C-peptide at fasting and every 30 min after ingestion and assessment of triglycerides at fasting state. All examinations were repeated at 24+0–27+6 weeks of gestation.ResultsElevated triglycerides in early gestation were associated with insulin resistance and β-cell dysfunction. Mean glucose concentrations during the OGTT in early pregnancy were already higher in women with hypertriglyceridemia as compared to women with triglycerides in the normal range. A higher degree of insulin resistance and increased OGTT glucose levels were also observed when metabolic assessments were repeated between 24 and 28 weeks of gestation. Of note, elevated triglycerides at early gestation were associated with development of gestational diabetes by logistic regression (odds ratio: 1.16, 95%CI: 1.03–1.34, p=0.022 for an increase of 10 mg/dl).ConclusionsHypertriglyceridemia at the start of pregnancy is closely related to impaired insulin action and β-cell function. Women with hypertriglyceridemia have higher mean glucose levels in early- and mid-gestation. Pregnant women with elevated triglycerides in early pregnancy are at increased risk of developing gestational diabetes.
Highlights
Gestational diabetes mellitus (GDM) is widely accepted as a major reason for adverse pregnancy outcomes including fetal macrosomia, cesarean section rate, neonatal hypoglycemia or the development of obesity in the newborns’1 3 Vol.:(0123456789)Acta Diabetologica (2021) 58:459–465 later life [1,2,3]
Previous studies indicated that alterations in maternal lipid metabolism were associated with adverse pregnancy outcomes, as elevated serum triglycerides concentrations were found to be associated with an increased risk of preeclampsia and the development of large for gestational age neonates [6]
The limited sample size has to be considered for interpreting these results, maternal triglycerides at early gestation were associated with development of GDM (OR: 1.16, 95%CI: 1.03–1.34, p=0.022 for an increase of 10 mg/dl), whereas this association was not observed for total cholesterol, HDL cholesterol and LDL cholesterol
Summary
Gestational diabetes mellitus (GDM) is widely accepted as a major reason for adverse pregnancy outcomes including fetal macrosomia, cesarean section rate, neonatal hypoglycemia or the development of obesity in the newborns’1 3 Vol.:(0123456789)Acta Diabetologica (2021) 58:459–465 later life [1,2,3]. Previous studies indicated that alterations in maternal lipid metabolism were associated with adverse pregnancy outcomes, as elevated serum triglycerides concentrations were found to be associated with an increased risk of preeclampsia and the development of large for gestational age neonates [6]. As known from studies of non-pregnant women, maternal lipids may be intercorrelated with obesity and parameters of disturbed glucose metabolism (especially insulin resistance), which are commonly known risk factors for the development of hyperglycemia [7]. Increased maternal lipid content could be regarded as a potential risk factor for hyperglycemia in pregnancy as well [4]. Only a few studies have addressed the possible cross-link between maternal triglyceride concentrations and parameters of glucose metabolism during gestation, and the evidence for possible clinical implications of increased lipid concentrations in pregnancy is sparse
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