Maternal Serum Lipid Levels in the Third Trimester and Associated Factors in Vietnam.

BackgroundMaternal glucose and lipid levels are known to influence fetal growth. However, data on how maternal lipid profiles affect birth size in women with gestational diabetes (GDM) compared with those without GDM are scarce.MethodsThis retrospective study included 10,490 women with singleton pregnancies (2351 with GDM and 8139 without GDM) between December 2016 and July 2022. Maternal serum levels of total cholesterol (TC), triglycerides (TGs), low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol were measured at 28–42 weeks of gestation. Maternal glucose levels were determined using the 2-h oral glucose tolerance test. The neonatal birth weight was obtained at delivery and standardized as the birth weight z score according to the INTERGROWTH-21st standards.ResultsCompared with women without GDM, those with GDM presented increased mean TG levels and decreased levels of TC, HDL cholesterol, and LDL cholesterol. TG levels were positively associated with birth weight in both the GDM and non-GDM groups, whereas TC, HDL cholesterol, and LDL cholesterol levels were mildly negatively correlated with birth weight. In the GDM group, an increase of 1 mmol/L in maternal TGs correlated with a 28.4 g increase in birth weight (95% CI: 17.8 to 39.1), whereas increases of 1 mmol/L in TC (-19.2 g; 95% CI: -31.9 to -6.5), HDL cholesterol (-120.7 g; 95% CI: -164.8 to -76.6), and LDL cholesterol (-22.2 g; 95% CI: -40.4 to -4) were associated with a decrease in birth weight. Compared with women with GDM with TG levels ≤ the 10th percentile, those with TG levels ≥ the 90th percentile had increased risks of large-for-gestational-age offspring (adjusted OR: 3.09; 95% CI: 1.51–6.30) and macrosomia (adjusted OR: 4.04; 95% CI: 1.37–11.93); this risk was stronger than that in women without GDM.ConclusionsThis study provides evidence of a significant association between maternal lipid levels during late pregnancy and offspring birth size. However, the observational nature of the study limits the ability to establish causal relationships regarding the direct impact of lipid levels on birth size. Additionally, the influence of maternal lipid profiles is disproportionately greater in women with GDM than in women without GDM.

BackgroundMaternal lipid levels in early pregnancy are associated with maternal health and foetal growth. It is however unclear if maternal lipids in early pregnancy can be used to predict childhood lipid levels. The aim of this study is to assess the association between maternal and offspring childhood lipid levels, and to investigate the influence of maternal BMI and diet on these associations.MethodsThis study included 2692 women participating in the Generation R study, an ongoing population-based prospective cohort study from early life onwards. Women with an expected delivery date between 2002 and 2006 living in Rotterdam, the Netherlands were included. Total cholesterol, triglycerides and high-density lipoprotein cholesterol (HDL-c) were measured in early pregnancy (median 13.2 weeks [90% range 10.6; 17.1]). Low-density lipoprotein cholesterol (LDL-c), remnant cholesterol and non-HDL-c were calculated. Corresponding lipid measurements were determined in 2692 children at the age of 6 (median 6.0 years [90% range 5.7; 7.5]) and 1673 children 10 years (median 9.7 years [90% range 9.5; 10.3]). Multivariate linear regression analysis was used to examine the association between maternal lipid levels in early pregnancy and the corresponding childhood lipid measurements at the ages of 6 and 10 years while adjusting for confounders.ResultsMaternal lipid levels in early pregnancy are positively associated with corresponding childhood lipid levels 6 and 10 years after pregnancy, independent of maternal body mass index and diet.ConclusionsMaternal lipid levels in early pregnancy may provide an insight to the lipid profile of children years later. Gestational lipid levels may therefore be used as an early predictor of children’s long-term health. Monitoring of these gestational lipid levels may give a window-of-opportunity to start early interventions to decrease offspring’s lipid levels and possibly diminish their cardiovascular risk later in life. Future studies are warranted to investigate the genetic contribution on maternal lipid levels in pregnancy and lipid levels of their offspring years later.

BackgroundSub-optimal maternal lipid levels during pregnancy may be implicated in the pathophysiological mechanisms leading to low birth weight (LBW) and small-for-gestational-age (SGA). We aimed to determine whether maternal lipid levels across pregnancy were associated with birth weight and the risks of LBW and SGA in rural Gambia.MethodsThis secondary analysis of the ENID trial involved 573 pregnant women with term deliveries. Plasma levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG) were analyzed at enrolment (mean (SD) = 13.9 (3.3) weeks gestation), 20 and 30 weeks gestation as continuous variables and percentile groups. Regression models with adjustment for confounders were used to examine associations between gestational lipid levels and birth weight and the risks of LBW (birth weight < 2500 g) and SGA (<10th percentile INTERGROWTH-21ST for birth weight).ResultsThere were 7.9% LBW and 32.5% SGA infants. At enrolment, every unit increase in HDL-c was associated with a 2.7% (P = 0.011) reduction in relative risk of LBW. At 20 weeks gestation, every unit increase in TC levels was associated with a 1.3% reduction in relative risk of LBW (P = 0.002). Low (<10th percentile) HDL-c at enrolment or at 20 weeks gestation was associated with a 2.6 (P = 0.007) and 3.0 (P = 0.003) times greater risk of LBW, respectively, compared with referent (10th─90th) HDL-c. High (>90th percentile) LDL-c at 30 weeks gestation was associated with a 55% lower risk of SGA compared with referent LDL-c (P = 0.017). Increased levels of TC (β = 1.3, P = 0.027) at 20 weeks gestation and of TC (β = 1.2, P = 0.006) and LDL-c (β = 1.5, P = 0.002) at 30 weeks gestation were all associated with higher birth weight.ConclusionsIn rural Gambia, lipid levels during pregnancy were associated with infant birth weight and the risks of LBW and SGA. Associations varied by lipid class and changed across pregnancy, indicating an adaptive process by which maternal lipids may influence fetal growth and birth outcomes.Trial registrationThis trial was registered as ISRCTN49285450 on: 12/11/2009.

Maternal BMI, lipid levels (cholesterol, triglyceride, LDL, HDL), and exercise amount are interrelated and each influence offspring body size. This study proposed to determine the influence of exercise on maternal lipid levels and infant body size. We had 36 participants complete these measures. Participants in the aerobic exercise intervention (n = 14) completed three 50-min sessions weekly from 16 weeks gestation to delivery and were compared with a non-exercise control group (n = 22). Maternal lipid profiles were assessed at 16 and at 36 weeks gestation. Fetal body size was measured at 36 weeks gestational age using ultrasound assessment. Neonatal body size measures were acquired from birth records. Statistical analysis included two-sample t-tests, correlations, and regression models. Participants were similar in age, pre-pregnancy BMI, gravida, parity, education, and gestational weight gain (GWG). There were no differences in gestational age, Apgar scores at 1 and 5 min for infants of exercisers relative to controls. Exercisers had higher pre-training triglycerides (p = 0.004) and pregnancy change in triglycerides (p = 0.049) compared to controls. Head circumference was significantly larger in exercise exposed infants relative to infants of controls. Pregnancy METs had a positive relationship with birth length (r = .445, p = .006) and birth weight (r = .391, p = .02). GWG had a moderate, positive relationship with fetal abdominal circumference (r = .570, p = .004). Regression analysis indicated 5 predictors explained 61.7% of the variance in birth weight (Adj.R2 = 0.469, F(5,13) = 5,13, p = 0.02); it was found that pregnancy METs (β = .724, p = .007), 36 week cholesterol (β = 1.066, p = .02), and 36 week LDL (β = -1.267, p = .006) significantly predict birth weight. Regression analysis indicated 4 predictors explained 43.8% of the variance in birth length (Adj.R2 = 0.306, F(4,17) = 3.32, p = 0.04); it was found that pregnancy METs (β = .530, p = .03), and 36 week LDL (β = -.891, p = .049) significantly predict birth length. The primary association and predictors of infant body size was related to pregnancy exercise and late pregnancy cholesterol and LDL levels. Considering these relationships, it is essential that women maintain aerobic exercise during pregnancy, but should also be cognizant of lipid levels during their pregnancy. Therefore intervention during pregnancy focused on infant body size should involve exercise and and quality nutritional intake foods during pregnancy.

Maternal obesity may be associated with metabolic factors that affect the intrauterine environment, fetal growth, and the offspring's long-term risk for chronic disease. Among these factors, maternal serum lipids play a particularly important role. Our objective was to estimate the influence of variation in maternal serum lipid levels on variation in infant birth weight (BW) in overweight/obese and normal weight women. In a prospective cohort of 143 gravidas, we measured maternal serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) at 6-10, 10-14, 16-20, 22-26, and 32-36 weeks gestation. Effects of maternal serum lipid levels on infant BW adjusted for gestational age at delivery (aBW) were analyzed using linear regression models. In analyses stratified by maternal prepregnancy BMI categorized as normal (≤25.0 kg/m(2)) and overweight/obese (>25.0 kg/m(2)), we found a significant (P < 0.05) inverse association between aBW and HDL-C at all time points starting at 10 weeks gestation in overweight/obese women. No significant effect was found in normal weight women. In contrast, increased maternal serum TG was significantly associated with increased aBW only for normal weight women at 10-14 and 22-26 weeks gestation. Variation in aBW is not associated with variation in maternal serum TC or LDL-C for either stratum at any time point. We postulate that such differences may be involved in the "physiological programming" that influences later risk of chronic disease in the infants of overweight/obese mothers.

Objective: The aim of the present study was to evaluate whether fasting may cause changes in maternal lipid profile, glucose level and ketonuria, and whether it has any adverse effects on fetal Doppler, birthweight, preterm delivery or cesarean section rate.Methods: Fifty-six consecutive, healthy women with singleton uncomplicated pregnancies of ≥28 week gestation who had fasted for at least 10 consecutive days during the study period were defined as the study group. Fifty-four healthy non-fasted women matched for age, parity, and gestational age were defined as the control group. Groups were compared according to fetal middle cerebral artery and umbilical artery systolic/diastolic ratio, maternal serum lipid levels and neonatal outcomes (gestational age at delivery, birthweight, delivery type and neonatal intensive care admission).Results: No statistical difference was found between the groups according to fetal Doppler parameters, amniotic fluid index, gestational age at delivery, cesarean section rate, birthweight or NICU admission. However, lower levels of VLDL, triglyceride and higher incidence of ketonuria were detected in the fasting group (p < 0.05).Conclusion: Fasting of healthy women during pregnancy seems to have no adverse effects on amniotic fluid index, fetal Doppler and delivery parameters.

The relationship of neonatal birth weight with maternal serum triglyceride (TG) level has been reported. This hospital‐based cohort study examined the relationship between maternal dietary intake and serum lipid levels in relation to neonatal births weights in 460 pregnant women and their babies. Maternal serum TG and HDL‐cholesterol (HDL‐C) were correlated with intakes of food and nutrients such as cereals and cereal products, meat and meat products, carbohydrates, and polyunsaturated fatty acid. After controlling for maternal age, babies' sex, income and history of low birth weight, the adjusted odds ratio of low birth weight (&lt;2.5kg) delivery was 6.1 (95% confidence intervals, 1.202‐30.707) in women with below the median serum TG level at parturition. The adjusted odds ratio of macrosomia (=4kg) delivery was 0.4 (95% confidence intervals, 0.133‐0.931) in women with above the median serum HDL‐C level. We suggest that maternal lipid levels at parturition of which dietary intake may have partial contribution throughout the pregnancy is associated with birth weight.*This work was supported by the Ministry of Environment and the 2nd stage of Brain Korea 21 project in 2008

ContextMaternal lipid levels affect birthweight and the long-term health of the offsprings. However, this association could be influenced by genetic and other common factors.ObjectiveThis work aimed to explore the relationship between maternal lipid levels and birthweight of two pregnancies in the same mother.MethodsIn this population-based cohort study, 705 women and their 1 410 offsprings were included. From an initial sample of women with more than one singleton birth in the database, we made the following exclusions: missing data for pre-pregnancy BMI, pregnancy weight gain, birthweight and lipid values; maternal age less than 19 or older than 44 years old; gestational age < 37 weeks or > 41weeks, gestational diabetes mellitus/diabetic. In the second and third trimesters, serum samples were collected for the determination of fasting total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels. Then we assessed the association between maternal lipids and birthweight.ResultsInfants of women whose 2nd-trimester TC increased by 10th-20th percentile (-0.92~-0.56 mmol/L) from 1st to 2nd pregnancy were 239.69 (62.32~417.06) g lighter at birth than were infants of women those of 40th-50th percentile (-0.20~-0.03 mmol/L). Parity, gestational age, neonatal gender, maternal pre-pregnancy body mass index, maternal weight gain, and 3rd-trimester TC and HDL-C were all associated with higher birth weight. Every unit increase in TC in the third trimester increases birthweight by 53.13 (14.32 ~91.94) g.ConclusionMaternal TC level is associated with birthweight independent of shared genes. TC may be used to guide diet and predict birthweight combined with ultrasound and other indicators.

To investigate whether umbilical cord serum lipid levels differ with mode of delivery. Retrospective observation study. Two hundred and ninety mothers aged 29.1 years (SD 4.7) who had vaginal delivery, and 44 mothers aged 30.4 years (SD 4.7) who had elective caesarean section were enrolled. Maternal and umbilical cord blood were obtained immediately after delivery. Serum lipid levels including total cholesterol, high density lipoprotein cholesterol, saturated fatty acid, mono-unsaturated fatty acid and polyunsaturated fatty acid were measured. Obstetric variables and serum lipid levels were compared between the two groups. In each group the correlations of fetal serum lipid levels with maternal serum lipid levels were investigated. There were no significant differences in maternal age, neonatal weight, gestational duration, placental weight and neonatal gender distribution between the two groups. Only the two fetal serum lipid levels (including total cholesterol and non-high density lipoprotein cholesterol) showed a correlation with maternal fetal lipid levels with correlation coefficients > 0.3 in the caesarean section group. However, saturated fatty acid, mono-unsaturated fatty acid and total fatty acid levels in the non-high density lipoprotein low density lipoprotein, very low density lipoprotein, intermediate density lipoprotein and free fatty acid fraction in the umbilical cord serum were significantly higher in the vaginal delivery cases (P < 0.01). Umbilical cord serum levels of saturated and mono-unsaturated fatty acids increase during vaginal delivery.

Recognizing Pregnancy-Associated Cardiovascular Risk Factors

Background Altered maternal serum lipid metabolism is associated with hypertensive disorders in pregnancy (HDP). However, its range in pregnancy and characteristic among different subgroups of HDPs are unclear. Methods Pregnant women with HDP who underwent antenatal care and delivered in Obstetrics and Gynecology Hospital of Fudan University during January 2018 to August 2022 were enrolled. The levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), apolipoprotein (Apo)-A, B, and E, free fatty acids (FFA), and small and dense low-density lipoprotein cholesterol (sdLDL) were measured during 4–16 weeks and 28–42 weeks of pregnancy. Results A total of 2648 pregnant women were diagnosed with HDP, 1,880 of whom were enrolled for final analysis, including 983 (52.3%) preeclampsia (PE), 676 (36.0%) gestational hypertension (GH), and 221 (11.7%) chronic hypertension (CH). For all HDPs, serum TC, TG, LDLC, HDLC, Apo-A, Apo-B, Apo-E, and sdLDL increased significantly during pregnancy, while FFA decreased significantly. Notably, the levels of TC, LDLC, Apo-B, and sdLDL in PE group were equal to or lower than those in CH group at 4–16 weeks of pregnancy, but increased greatly during pregnancy (P < 0.05). Conclusions Maternal serum lipid levels changed through pregnancy among women with HDPs. Women complicated with PE seem to have undergone a more significant serum lipid change compared to those with GH or CH.

Objective To investigate the relationship of prepregnancy weight and lipid levels of late pregnancy in gestational diabetes mellitus（GDM）with neonatal birth weight. Methods Fifty-two normal glucose tolerance（NGT）pregnant women（control group）and 52 pregnant women with gestational diabetes mellitus（ GDM group）were chose. Hitachi 7080 automatic biochemical analyzer was used to measure the serum levels of total cholesterol（TC）,triglyceride（TG）,high density lipoprotein cholesterol （HDL-C）,low density lipoprotein cholesterol（LDL-C）and lipoprotein（a）[LP（a）]. At the same time, maternal age,gestational age,body weight before pregnancy and fetal birth weight were recorded in the two groups. Results Prepregnancy weight and the levels of TG and LDL-C were significantly higher in GDM group than those in control group（P 〈0. 01）. Prepregnancy weight and the TG was postively correla-ted with neonatal birth weight（P 〈0. 05）. The LP（a）was negatively correlated with neonatal birth weight （P 〈0. 05）. Conclusions Hyperlipidemia including TG and LDL-C in pregnant women with gestational diabetes mellitus are elevated. Gestational diabetes compared with pregnant women with normal glucose tol-erance,has more serious abnormal lipid metabolism,and it significantly affect the neonatal birth weight. Therefore,it has important clinical significance of controling body weight before pregnancy and monitoring serum lipid levels in pregnancy and the necessary dietary guidance for women with gestational diabetes. Key words: Gestational diabetes mellitus; Prepregnancy weight; Lipid; Neonatal birth weight

Objective: This study aims to characterize changes in serum lipid levels throughout twin pregnancies and explore the relationship between lipid levels and gestational diabetes mellitus (GDM) and hypertensive disorders complicating pregnancy (HDCP). Methods: We retrospectively studied 297 twin pregnancies of women who received regular prenatal care and delivered at the Beijing Obstetrics and Gynecology Hospital over a period of two years. Demographic and medical data of the participants were collected by questionnaires and medical records review. Serum lipid levels were measured in the first trimester (6–13 weeks), second trimester (24–28 weeks), and third trimester (34–37 weeks). A multivariate regression model was constructed to examine the association between lipid levels and pregnancy complications. A decision tree was used to explore the relationship between early serum lipid glucose levels and GDM and HDCP in twin pregnancies. Results: Triglyceride (TG), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels increased significantly from the first trimester to the third trimester, with the exception of high-density lipoprotein cholesterol (HDL-C), which decreased in the third trimester in twin pregnancies (p < 0.001). The levels of TC in the GDM and HDCP group were significantly elevated compared to those in the normal group in early pregnancies (p < 0.05, p < 0.05). In the second trimester, TG in the HDCP group was substantially higher than that in the normal group (p = 0.01). In the third trimester, LDL-C and HDL-C levels in the GDM group are significantly lower than that in the normal group (p < 0.05, p < 0.05). After adjusting for confounders, body mass index (BMI) is independently associated with GDM (odds ratio [OR] = 1.129, 95% confidence interval [CI]: 1.007–1.266) and HDCP(odds ratio [OR] = 1.170, 95% confidence interval [CI]: 1.031–1.329). The variation amplitude of HDL-C in the third trimester is related to the occurrence of GDM and HDCP(GDM:OR = 0.271, 95%CI: 0.095–0.778; HDCP: OR =0.249, 95% CI: 0.075–0.823). TG and TC levels in DCDA twins were significantly higher than that in MCDA twins in the first trimester(TG: p < 0.05, TC: p < 0.05). In the decision tree model for GDM, fasting blood glucose in the first trimester (FBG), TC, and pre-pregnancy BMI were identified as important nodes, while in the HDCP model, pre-pregnancy BMI, TC, and TG were key nodes. Conclusion: Serum lipid levels in twin pregnancies increase gradually during pregnancy. BMI is independently associated with the occurrence of GDM and HDCP. HDL-C may serve as a protective factor for GDM and HDCP. The predictive effect of early blood lipid on GDM and HDCP in twin pregnancy needs further study.

Exploring Avenues for Raising HDL Cholesterol

Lipid levels during pregnancy in women with gestational diabetes mellitus (GDM) have been extensively studied; however, it remains unclear whether dyslipidaemia is a potential marker of preexisting insulin resistance. To evaluate the relationship between lipid measures throughout pregnancy and GDM. We searched PubMed-MedLine and SCOPUS (inception until January 2014) and reference lists of relevant studies. Publications describing original data with at least one raw lipid (total cholesterol, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], or triglyceride) measurement during pregnancy in women with GDM and healthy pregnant controls were retained. Data extracted from 60 studies were pooled and weighted mean difference (WMD) in lipid levels was calculated using random effects models. Meta-regression was also performed to identify sources of heterogeneity. Triglyceride levels were significantly elevated in women with GDM compared with those without GDM (WMD 30.9, 95% confidence interval [95% CI] 25.4-36.4). This finding was consistent in the first, second and third trimesters of pregnancy. HDL-C levels were significantly lower in women with GDM compared with those without GDM in the second (WMD -4.6, 95% CI -6.2 to -3.1) and third (WMD -4.1, 95% CI -6.5 to -1.7) trimesters of pregnancy. There were no differences in aggregate total cholesterol or LDL-C levels between women with GDM and those without insulin resistance. Our meta-analysis shows that triglycerides are significantly elevated among women with GDM compared with women without insulin resistance and this finding persists across all three trimesters of pregnancy.