Abstract
We review current knowledge on lipid metabolism changes during pregnancy with special focus on changes in gestational diabetes. In physiological pregnancy, total plasma cholesterol, triglyceride and HDL-cholesterol level rises, the atherogenic index (LDL-cholesterol / HDL-cholesterol remains unchanged. Compared with healthy women, women with GDM show more pronounced signs of mixed dyslipidaemia - increased levels of triglyceride, changes in cholesterol and lipoprotein concentrations with a shift towards greater small dense LDL subtractions, which is typical for insulin resistance states. Dyslipidaemia, particularly hypertriglyceridemia, is thought to be one of the key drivers of foetal macrosomia and that is why measurements of plasma lipids may be valuable in detecting the metabolic abnormality in GDM and in predicting foetal outcome. Dyslipidaemia in GDM is seen as proatherogenic and potentially harmful for the baby and therefore it should be monitored more carefully.
Highlights
Insulin resistance in pregnancy leads to metabolic changes similar as can be to those found in type 2 diabetes mellitus
This study showed enrichment of triglycerides in lipoprotein particles (VLDL, low-density lipoproteins (LDL), high-density lipoproteins (HDL)) and a rise in free fatty acids and beta-hydroxybutyrate in pregnancy[17]
VLDL = very-low-density lipoprotein, LDL = low-density lipoprotein, HDL = high-density lipoprotein; increased, significantly increased, not influenced, decreased significantly, especially in the second trimester in women with GDM whereas the most prominent change in TG levels occurred in the third semester (2.5 to 2.7fold increase in comparison with non-pregnant women)
Summary
Insulin resistance in pregnancy leads to metabolic changes similar as can be to those found in type 2 diabetes mellitus. Women with normal pregravid glucose tolerance who develop GDM in pregnancy likely have subclinical metabolic dysfunction prior to conception compared with those who do not develop GDM during pregnancy[2]. It has been shown that women who developed GDM had a smaller LDL peak diameter, lower mean HDL concentrations, and higher mean concentrations of small, dense LDL particles before pregnancy These parameters were associated with the subsequent development of GDM, independently of other known risk factors (body mass index, weight gain before pregnancy, age, insulin resistance, and family history of diabetes) (ref.[4]). Mild forms of hyperlipidaemia are common during normal pregnancy, and extreme hyperlipoproteinaemia may occur in the gestational period In these cases, there is usually an underlying genetic disorder (e.g. lipoprotein lipase deficiency, ApoE3/3 genotype, dysbetalipoproteinaemia). Pregnant women with dyslipidaemia have higher incidence rates of preeclampsia, cholestasis, and foetal growth retardation[9]
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