Specialists from centers in Be’er-Sheva, Israel, and Boston, Massachusetts, USA, analyzed data on singleton deliveries between January 2000 and February 2006 to identify a total of 9,911 women who had lipid levels measured at some point in the period from 1 year before conception to 1 year after delivery, and who were free of cardiovascular morbidity. The aim was to test the hypothesis, based on the findings of previous studies, that high levels of triglycerides and low levels of high-density lipoprotein (HDL) are associated with an increased risk of gestational diabetes and pre-eclampsia.
A comparison group comprised 31,646 women who had singleton deliveries in the same period and were without cardiovascular morbidity, but who did not have lipid levels recorded.
Of the 9,911 women, 3,058 had lipid levels assessed in the year before conception, 3,983 had levels assessed during pregnancy, and 2,870 had levels assessed in the year following delivery. The mean age of the women was 29.6 years, slightly older than the comparison group, who had a mean age of 28.8 years.
The women in the study group also had a higher rate of use of infertility treatment (2.9 percent) than the comparison group (1.8 percent). The median number of pregnancies and deliveries was three in both groups.
Changes in lipid levels:
When the researchers plotted lipid levels over time, excluding women who had gestational diabetes and/or pre-eclampsia (leaving a population of 8,700 for this analysis), they found that levels of triglycerides, low-density lipoprotein (LDL), and total cholesterol remained stable before conception then fell to a low point in the second gestational month. The levels then increased sharply to a peak in the month of delivery, before falling back to near pre-conception levels within 4 months of delivery.
The mean triglyceride level, for example, was 92.6 mg/dL before conception, falling to a nadir of 77.4 mg/dL in the second gestational month, before rising to a peak of 238.4 mg/dL in the month of delivery.
Levels of HDL followed the same overall pattern as the other lipid measures but peaked slightly earlier in pregnancy, in the seventh gestational month, then remained stable until delivery.
Lipids and complications:
The researchers found that the composite primary endpoint of gestational diabetes and pre-eclampsia occurred in 12.2 percent of the study group (6.4 percent of women had gestational diabetes and 6.3 percent had pre-eclampsia). This was a significantly higher composite rate than seen in the comparison group, where 8.8 percent had either gestational diabetes or pre-eclampsia (4.2 percent had gestational diabetes and 4.4 percent had pre-eclampsia).
To examine the relationships between lipid levels and these complications, the researchers divided the women who were tested during pregnancy into three groups for each individual lipid test:
- Low level: below the 25th percentile of the distribution for the relevant gestational month.
- Intermediate level: from the 25th to the 75th percentile.
- High level: above the 75th percentile.
They found that triglyceride levels during pregnancy were significantly associated with the risk of complications (p <>
In their full paper, scheduled for publication in the American Journal of Obstetrics & Gynecology and currently available online from the journal’s website, the researchers (Wiznitzer A et al) present detailed plots of the changes in lipid levels over time before, during, and after pregnancy. They also discuss the possible underlying mechanisms for the link with the complications studied.
The researchers point out, however, that because the women who had lipid levels recorded were slightly older than the untested women, the results “may not be fully generalizable to all pregnant women”. They conclude that high levels of triglycerides are associated with pregnancy complications, but say prospective studies are needed to evaluate the link between lipid levels and complications in more detail.
Source: Orgyn.com
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