Abstract
Introducción. Durante el embarazo, los niveles séricos de triglicéridos maternos aumentan como un mecanismo de adaptación fisiológica para suplir las necesidades del feto en desarrollo. Pese a que el incremento excesivo se ha asociado a preeclampsia, macrosomía y parto pretérmino, no se han establecido de manera contundente los niveles a partir de los cuales se deben tomar medidas en cada trimestre para prevenir complicaciones.Objetivo. Hacer una revisión sobre fisiopatología, efectos en madre e hijo, valores esperados en cada trimestre e intervenciones terapéuticas en hipertrigliceridemia gestacional.Materiales y métodos. Se realizó una revisión con la búsqueda de artículos en las bases de datos ScienceDirect, PubMed, Scopus, LILACS, Cochrane y SciELO con los términos: Pregnancy; Hypertriglyceridemia; Maternal-Fetal Exchange; Fetal Development; Pregnancy Complications y sus equivalentes en español.Resultados. Se encontraron 59 artículos que cumplieron los criterios de búsqueda y daban respuesta a los objetivos.Conclusiones. El número limitado y la gran variabilidad de los datos indican la necesidad de realizar más investigaciones que establezcan los rangos de normalidad de los triglicéridos durante los tres trimestres del embarazo y así determinar riesgos e intervenciones eficaces antes de la gestación y reducir la morbimortalidad materno-infantil.
Highlights
During pregnancy, levels of maternal serum triglycerides increase as a physiological adaptation mechanism to meet the needs of the developing fetus
The abovementioned events are related to the insulin resistance that occurs during pregnancy, which may be caused by the increase of non-esterified fatty acids, changes in adipokines secretion and inflammatory factors. [1,2,17] Increased lipolysis has been associated with increased placental lactogen, progesterone, prolactin, cortisol and estrogen. [2,19] Adiponectin and apelin, which favor insulin sensitivity, decrease in the third trimester, while other adipokines and cytokines that reduce insulin sensitivity increase at the end of pregnancy, including resistin, retinol binding protein 4 (RBP4), leptin, visfatin, chemerin, adipocyte fatty acid binding protein (AFABP), tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) [2]
A prospective cohort study conducted in Egypt (n=251) showed that TG levels between weeks 4 and 12 of pregnancy can be predictors of PE development. [5,8] This study found that the increase in total cholesterol (TC), TG and LDL greater than 231 mg/dL, 149.5 mg/ dL and 161 mg/dL, respectively, and the decrease in high density lipoproteins (HDL) below 42.5 mg/dL are cutoff points with positive predictive value for the development of PE, while TC and TG increase was related to severity
Summary
Mother’s physiology adapts to provide nutrients to the growing fetus. Pregnancy is a state of metabolic stress associated with high TG levels [17], which increase during this period; the highest concentrations are observed during the third trimester. [1] This increase is related to the decrease in the synthesis of fatty acids and the activity of the lipoprotein lipase (LPL) that catalyzes the hydrolysis of TG-rich lipoproteins in the adipose tissue. The abovementioned events are related to the insulin resistance that occurs during pregnancy, which may be caused by the increase of non-esterified fatty acids, changes in adipokines secretion and inflammatory factors. [2,19] Adiponectin and apelin, which favor insulin sensitivity, decrease in the third trimester, while other adipokines and cytokines that reduce insulin sensitivity increase at the end of pregnancy, including resistin, retinol binding protein 4 (RBP4), leptin, visfatin, chemerin, adipocyte fatty acid binding protein (AFABP), tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) [2]. A study carried out in Amsterdam (n=4 008) revealed that TG increase in the first trimester of pregnancy is directly associated with pregnancyinduced hypertension, PD and LGA. [3] Likewise, a research carried out in India (n=180) found that high TG levels (≥195 mg/dL) in the second trimester are associated with a higher incidence of PD, GDM, PE and LGA. [4] Another complication is maternal pancreatitis, which must be mentioned due to its severity (Table 1). [14,18]
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