Abstract
Background: Gestational Diabetes Mellitus (GDM) is an emerging problem which affects a large number of pregnant women in India. Women with GDM have been shown to have abnormal lipid profiles with higher serum triacylglycerol concentrations but lower LDL levels. Early detection reduces adverse maternal and foetal outcome. The Lipid Accumulation Product (LAP) is an index of fat distribution and assessment which can be easily measured in an outpatient setup. Methods: This study was a hospital based case control study. Cases were 30 pregnant women, newly diagnosed with GDM in their 2nd trimester while controls were 30 apparently healthy pregnant women without risk factors for GDM. Lipid accumulation product (LAP) was computed by multiplying a sex-specific estimate of waist circumference and the fasting triglyceride concentration, LAP = (WC [cm] - 58) x TGL [mmol/L]. Result: The mean age of patients with GDM was higher when compared to controls. (28.17 ± 3.34 vs 24.40 ± 3.07, p < 0.0001) The lipid profile showed a significantly higher value of serum triglycerides among cases while the differences in HDL were not statistically significant. Lipid accumulation product (LAP) in GDM patients was found to be significantly elevated when compared to controls. (133.43 ± 64.02 vs 62.89 ± 30.68, p < 0.0001) Conclusion: Calculation of LAP can be done to identify the degree of risk for developing GDM. So LAP can possibly serve as in future as a screening tool for the diagnosis of GDM in an outpatient setting in resource poor settings. DOI: 10.21276/AWCH.1461
Highlights
Gestational Diabetes Mellitus (GDM) is defined as carbohydrate intolerance of variable severity, with onset or first recognition during pregnancy.[1,2] The incidence of GDM has increased over the past few decades in parallel with the increase in rates of obesity and type 2 diabetes mellitus, and this trend is expected to continue in the near future too.[3]Physiological hyperlipidemia, is associated with an increase in TGL, LDL and very low-density lipoprotein (VLDL) levels and a decrease in HDL – C levels
Calculation of Lipid Accumulation Product (LAP) can be done to identify the degree of risk for developing GDM
It occurs in some pregnancies without causing any adverse pregnancy associated alterations and in some pregnancies coursing with pathologies as preeclampsia and gestational diabetes mellitus (GDM)
Summary
Gestational Diabetes Mellitus (GDM) is defined as carbohydrate intolerance of variable severity, with onset or first recognition during pregnancy.[1,2] The incidence of GDM has increased over the past few decades in parallel with the increase in rates of obesity and type 2 diabetes mellitus, and this trend is expected to continue in the near future too.[3]Physiological hyperlipidemia, is associated with an increase in TGL, LDL and VLDL levels and a decrease in HDL – C levels. Women with GDM have been shown to have higher serum triacylglycerol concentrations but lower LDL than normal pregnant women. The inverse association between high-triglyceride and low HDL – Cholesterol pattern is readily apparent in women with GDM.[4] This ratio (TG/HDL-C) has been confirmed as a clinical indicator of insulin resistance.[5] Higher plasma insulin levels may suppress fatty acid oxidation and thereby contribute to the elevated triglycerides in blood. Hyperinsulinemia is known to enhance hepatic very low-density lipoprotein (VLDL) synthesis, which may further contribute to increased plasma triglycerides and LDL – C levels. Women with GDM have been shown to have abnormal lipid profiles with higher serum triacylglycerol concentrations but lower LDL levels. The Lipid Accumulation Product (LAP) is an index of fat distribution and assessment which can be measured in an outpatient setup
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