The associations between early pregnancy lipid profiles and pregnancy outcomes

To evaluate the association between early pregnancy lipid profiles and pregnancy outcomes.

Retrospective 6 months analysis of 5218 singleton pregnant women. Each participant's demographic and medical data were collected by questionnaires and medical records. Total cholesterol (TC), triglycerides (TG), high-density lipid cholesterol (HDL-C) and low-density lipid cholesterol (LDL-C) levels were divided into quartiles, and the women were categorized as having low (<25th percentile), referent (25 to <75th percentile) or high (>75th percentile) TC, TG, HDL-C and LDL-C values. Differences between groups were tested using t-test and Pearson's χ²-test. Binary logistic regression and multivariate analysis was conducted to evaluate the associations between lipid values and the risk of pregnancy outcomes.

(1) Women who subsequently developed adverse pregnancy outcomes had higher levels of TC, TG, LDL-C and lower levels of HDL-C during early pregnancy (<14 gestational weeks). (2) A trend toward an increasing incidence of adverse pregnancy outcomes was noted with increasing levels of TC, TG and LDL-C, and decreasing level of HDL-C. (3) The more numbers of TC, TG and LDL-C above 75th percentile and HDL-C inferior to 25th percentile women had, the higher their risk of developing adverse pregnancy outcomes. (4) Low TG level was a protective factor for gestational diabetes mellitus (GDM) (<1.44 mmol l^-1, odds ratio (OR)=0.706, 95% confidence interval (CI), 0.586 to 0.852) and large for gestational age infants (LGA) (<1.44 mmol l^-1, OR=0.769, 95% CI, 0.631 to 0.936), and low LDL-C (<1.89 mmol l^-1) level was protective factor for preterm birth. High TG (>1.40 mmol l^-1, OR=1.327, 95% CI, 1.130 to 1.558), TC (>4.29 mmol l^-1, OR=1.250, 95% CI, 1.062 to 1.471), and LDL-C (>2.62 mmol l^-1, OR=1.25, 95% CI, 1.069 to 1.480) levels and a low HDL-C (<1.89 mmol l^-1, OR=1.190, 95% CI, 1.007 to 1.405) level were associated with increased risk of GDM. A high TG (>1.40 mmol l^-1, OR=1.550, 95% CI, 1.025 to 2.343) level was related to high risk of pre-eclampsia (PE), while a high LDL-C (>2.62 mmol l^-1, OR=1.400, 95% CI, 1.100 to 1.781) level was risk factor for macrosomia. (5) After adjusting for confounders, early pregnancy TC was an independent risk factor for GDM (ajusted odds ratio [aOR]=1.184, 95% CI, 1.085 to 1.291), TG level was independently associated with the prevalence of GDM (aOR=1.253, 95% CI, 1.141 to 1.375) and PE (aOR=1.245, 95% CI, 1.023 to 1.516), and LDL-C level was significantly associated with risk of GDM (aOR=1.162, 95% CI, 1.052 to 1.283) and preterm birth (aOR=1.264, 95% CI, 1.065, 1.501).

Early pregnancy high levels of TC, TG, LDL-C and low level of HDL-C may be predictive biomarkers for adverse pregnancy outcomes, while early pregnancy low TC, TG, LDL-C levels and high HDL-C levels could have some protective roles.