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Prepregnancy lipids related to preterm birth risk: the coronary artery risk development in young adults study
Janet M Catov1, Roberta B Ness, Melissa F Wellons
1Department of Obstetrics and Gynecology, University of Pittsburgh, 300 Halket Street, Pittsburgh, Pennsylvania 15213, USA. catovjm@upmc.edu
Insights
Both low and high prepregnancy cholesterol levels are linked to an increased risk of preterm birth. These findings suggest distinct pathways may contribute to this complex pregnancy outcome.
Area of Science:
- Reproductive Health
- Cardiovascular Health
- Perinatal Medicine
Background:
- Preterm birth is a significant concern linked to maternal cardiovascular disease.
- The underlying mechanisms connecting preterm birth and cardiovascular risk remain unclear.
- Dyslipidemia may be a shared risk factor for both conditions.
Purpose of the Study:
- To investigate the association between prepregnancy lipid profiles and the risk of preterm birth.
- To test the hypothesis that abnormal prepregnancy plasma lipid concentrations (low or high) are associated with preterm birth.
Main Methods:
- Analysis of data from 1010 women in the Coronary Artery Risk Development in Young Adults study.
- Prospective follow-up for singleton births over 20 years.
- Evaluation of preterm birth outcomes (<34 weeks and 34 to <37 weeks gestation) in relation to prepregnancy cholesterol levels.
Main Results:
- A U-shaped relationship was observed between prepregnancy cholesterol and preterm birth risk.
- Low cholesterol (lowest quartile) increased risk for preterm birth (<37 weeks).
- High cholesterol (highest quartile) also increased risk for preterm birth (<34 weeks), particularly in normotensive pregnancies.
Conclusions:
- Both low and high prepregnancy cholesterol concentrations are associated with an elevated risk of preterm birth.
- These lipid abnormalities may indicate separate biological pathways contributing to preterm birth.
- Further research is needed to understand the mechanisms linking cholesterol levels to preterm birth and long-term health.
Context:
Preterm birth is associated with maternal cardiovascular risk, but mechanisms are unknown.
Objective:
We considered that dyslipidemia may predispose women to both conditions and that prepregnancy lipids may be related to preterm birth risk. We hypothesized that low or high prepregnancy plasma lipids would be associated with preterm birth.
Design, Setting, And Participants:
A total of 1010 women (49% black) enrolled in the multicenter, prospective Coronary Artery Risk Development in Young Adults study with at least one singleton birth during 20 yr of follow-up were evaluated.
Main Outcome Measure:
Postbaseline preterm births less than 34 wk or 34 to less than 37 wk vs. greater than 37 wk gestation.
Results:
We detected a U-shaped relationship between prepregnancy cholesterol concentrations and preterm birth risk. Women with prepregnancy cholesterol in the lowest quartile compared with the second quartile (<156 vs. 156-171 mg/dl) had an increased risk for preterm birth 34 to less than 37 wk (odds ratio 1.86; 95% confidence interval 1.10, 3.15) and less than 34 wk (odds ratio 3.04; 1.35, 6.81) independent of race, age, parity, body mass index, hypertension during pregnancy, physical activity, and years from measurement to birth. Prepregnancy cholesterol in the highest quartile (>195 mg/dl) was also associated with preterm birth less than 34 wk among women with normotensive pregnancies (odds ratio 3.80; 95% confidence interval 1.07, 7.57). There were no associations between prepregnancy triglycerides, low-density lipoprotein cholesterol, or high-density lipoprotein cholesterol and preterm birth.
Conclusions:
Both low and high prepregnancy cholesterol were related to preterm birth risk. These may represent distinct pathways to the heterogeneous outcome of preterm birth. Additional studies are needed to elucidate mechanisms that link low or high cholesterol to preterm birth and later-life sequelae.
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