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Brief overview of maternal triglycerides as a risk factor for pre-eclampsia
1Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. rayj@smh.toronto.on.ca
Background:
Features of the metabolic syndrome-maternal obesity, diabetes mellitus and chronic hypertension-are risk factors for pre-eclampsia.
Objectives:
To determine the risk of pre-eclampsia in the presence of maternal hypertriglyceridemia, another major element of the metabolic syndrome.
Search Strategy:
Two investigators independently searched PubMed and Embase databases from 1980 to December 2004 for relevant studies. The terms preeclampsia, eclampsia, pregnancy-induced hypertension or toxemia were combined with dyslipidemia, hyperlipidemia, hypertriglyceridemia, lipids, cholesterol, triglycerides (TG) or lipoprotein.
Selection Criteria:
We included case-control and cohort studies published in English that included at least 20 women with pre-eclampsia and that sampled serum or plasma TG at any time before, during or after pregnancy.
Data Collection And Analysis:
Mean maternal TG concentrations were compared between cases and controls within each study. The odds ratio of pre-eclampsia was calculated by comparing the risk of pre-eclampsia among women in each higher TG concentration category with that in the lowest reference category.
Main Results:
A total of 19 case-control and 3 prospective cohort studies were included. In 14 studies, the mean TG concentration was significantly higher among pre-eclamptic cases than among unaffected controls; in seven other studies, there was a nonsignificant trend in the same direction. The risk of pre-eclampsia typically doubled with each increasing TG category. In the four studies that adjusted for potential confounders, such as maternal age, parity and body mass index, there was about a four-fold higher risk of pre-eclampsia in the highest relative to the lowest TG category.
Author'S Conclusions:
There exists a consistent positive association between elevated maternal TG and the risk of pre-eclampsia. Given that maternal hypertriglyceridemia is a common feature of the metabolic syndrome, interventional studies are needed to determine whether pre-pregnancy weight reduction and dietary modification can lower the risk of pre-eclampsia.
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