Abstract
IntroductionThe association between glucose intolerance, elevated blood pressure and abnormal lipid levels is well established and comprises the basis of metabolic syndrome pathophysiology. We hypothesize that abnormal preconception lipid levels are associated with the increased risk of severe pregnancy complications such as preeclampsia and gestational diabetes mellitus.MethodsWe included all singleton deliveries (n = 27,721) of women without known cardiovascular morbidity and preeclampsia and gestational diabetes mellitus during previous pregnancies. Association between preconception low high density lipoprotein cholesterol (HDLc level≤50 mg/dL), high triglycerides (level≥150 mg/dL) and the primary outcome (composite of gestational diabetes mellitus/or preeclampsia) was assessed using Generalized Estimation Equations.ResultsPrimary outcome of preeclampsia and/or gestational diabetes was observed in a total of 3,243 subjects (11.7%). Elevated triglycerides and low HDLc were independently associated with the primary outcome: with odds ratio (OR) of 1.61 (95% CI 1.29–2.01) and OR = 1.33 (95% CI 1.09–1.63), respectively, after adjusting for maternal age, weight, blood pressure, repeated abortions, fertility treatments and fasting glucose. There was an interaction between the effects of HDLc≤50 mg/dL and triglycerides≥150 mg/dL with an OR of 2.69 (95% CI 1.73–4.19).ConclusionsOur analysis showed an increased rate of preeclampsia and/or gestational diabetes in women with low HDLc and high triglycerides values prior to conception. In view of the severity of these pregnancy complications, we believe this finding warrants a routine screening for the abnormal lipid profile among women of a child-bearing age.
Highlights
The association between glucose intolerance, elevated blood pressure and abnormal lipid levels is well established and comprises the basis of metabolic syndrome pathophysiology
Primary outcome of preeclampsia and/or gestational diabetes was observed in a total of 3,243 subjects (11.7%)
Elevated triglycerides and low high density lipoproteins cholesterol (HDLc) were independently associated with the primary outcome: with odds ratio (OR) of 1.61 and OR = 1.33, respectively, after adjusting for maternal age, weight, blood pressure, repeated abortions, fertility treatments and fasting glucose
Summary
The association between glucose intolerance, elevated blood pressure and abnormal lipid levels is well established and comprises the basis of metabolic syndrome pathophysiology. We hypothesize that abnormal preconception lipid levels are associated with the increased risk of severe pregnancy complications such as preeclampsia and gestational diabetes mellitus. Indicating possible common pathophysiology, women with gestational diabetes mellitus are at increased risk for preeclampsia [1, 2] Both of these pregnancy-related disorders are associated with development of future chronic diseases, i.e. type 2 diabetes and hypertension. Abnormally elevated triglycerides (the additional component of the metabolic syndrome), total cholesterol and low density lipoprotein cholesterol (LDLc) measured in pregnancy were all found to be associated with preeclampsia [1, 6, 7, 8]. High gestational triglyceride levels alone were shown to have an adverse impact on the composite outcome of preeclampsia and /or gestational diabetes mellitus [6]
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