Associations between Maternal Lipid Profiles and Pregnancy Complications: A Prospective Population-Based Study

Objective: To investigate whether plasma lipid profiles are independently associated with pregnancy complications including gestational diabetes mellitus (GDM), hypertensive disorder complicating pregnancy (HDCP), and intrahepatic cholestasis of pregnancy (ICP).

Study design: A prospective study was conducted among 1,704 pregnant women at three medical institutions in Chengdu, China. The concentrations of triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured at gestational weeks 12 ± 1, 24 ± 1, and 34 ± 1. Logistic regression models were used to estimate the association between lipid profiles and pregnancy complications. Receiver operating characteristic analysis was performed to determine the value of lipid profiles to predict GDM and HDCP.

Results: After adjusting for potential confounders, TG, TC, and LDL-C in the first trimester were independently associated with GDM (TG: odds ratio [OR] =2.00, 95% confidence interval [CI]: 1.57-2.56; TC: OR = 1.38, 95% CI: 1.16-1.64; LDL-C: OR = 1.43, 95% CI: 1.14-1.79) and HDCP (TG: OR = 2.42, 95% CI: 1.56-3.78, TC: OR = 1.64, 95% CI: 1.04-2.57; LDL-C: OR = 1.87, 95% CI: 1.07-3.25). The TC concentration during the whole pregnancy (first trimester: OR = 1.53, 95% CI: 1.13-2.08; second trimester: OR = 1.31, 95% CI: 1.06-1.61; third trimester: OR = 1.39, 95% CI: 1.17-2.04) and LDL-C in the last two trimesters (second trimester: OR = 1.62, 95% CI: 1.30-2.04; third trimester: OR = 1.56, 95% CI: 1.29-1.88) were positively associated with ICP. HDL-C in the third trimester was negatively associated with the risk of ICP (OR = 0.46, 95% CI: 0.22-0.98). Combining lipid profiles in the first trimester with the other common predictors to predict GDM or HDCP owned stronger predictive power with the largest area under the curve (GDM: 0.643 [95% CI: 0.613-0.673], HDCP: 0.707 [95% CI: 0.610-0.804]) than either indicator alone.

Conclusion: Maternal lipid profiles during the whole pregnancy are significantly associated with GDM, HDCP, and ICP. Combining lipid profiles in the first trimester with the other common predictors could effectively improve the power of predicting GDM and HDCP.