ASSOCIATION OF LIPID LEVELS DURING GESTATION COMPLICATED WITH GESTATIONAL DIABETES MELLITUS AND EARLY PREDICTION OF GESTATIONAL DIABETES MELLITUS BY FIRST TRIMESTER LIPID VALUES
Keywords:
pregnancy, gestational diabetes mellitus, early prediction, lipids, lipid profile
Abstract
Pregnancy induces intricate physiological changes, including alterations in lipid profiles crucial for fetal development. The transition from an anabolic to a catabolic phase in the third trimester reflects increasing insulin resistance, facilitating lipid breakdown for fetal energy. Physiological pregnancy exhibits significant lipid profile changes, with dyslipidemia linked to negative effects on maternal and fetal health. Dyslipidemia in pregnancy correlates strongly with cases of pregnancy-related high blood pressure and diabetes. Gestational diabetes mellitus (GDM) introduces distinctive lipid alterations, including elevated triglycerides (TG) and low-density lipoprotein particles. Mixed dyslipidemia in GDM, exceptionally high TG, and reduced levels of high-density lipoprotein cholesterol (HDL-C) are linked to negative perinatal outcomes, emphasizing the importance of lipid profile assessment. Evaluating lipid profiles, especially TG levels, in early pregnancy proves valuable in predicting GDM. The ratio of triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) shows potential as a predictive marker for GDM, demonstrating commendable sensitivity and specificity. Elevated TG levels, even before 28 weeks, increase GDM risk, emphasizing the role of lipid markers in early detection. Early predictions of GDM through plasma lipid profiling offer a promising avenue for enhancing antenatal care. While standardized markers and thresholds require further research, integrating lipid profiles into routine screenings may optimize GDM management, ultimately benefiting both the mother and fetus.
References
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[2] Herrera E. Lipid Metabolism in Pregnancy and its Consequences in the Fetus and Newborn. Endocrine 2002;19:43–56. https://doi.org/10.1385/ENDO:19:1:43.
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[4] Hajar Sharami S, Abbasi Ranjbar Z, Alizadeh F, Kazemnejad E. The relationship of hyperlipidemia with maternal and neonatal outcomes in pregnancy: A cross-sectional study. Int J Reprod Biomed 2019. https://doi.org/10.18502/ijrm.v17i10.5294.
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[8] Rahnemaei FA, Pakzad R, Amirian A, Pakzad I, Abdi F. Effect of gestational diabetes mellitus on lipid profile: A systematic review and meta-analysis. Open Medicine 2021;17:70–86. https://doi.org/10.1515/med-2021-0408.
[9] Powe CE, Huston Presley LP, Locascio JJ, Catalano PM. Augmented insulin secretory response in early pregnancy. Diabetologia 2019;62:1445–52. https://doi.org/10.1007/s00125-019-4881-6.
[10] Williams C, Coltart TM. ADIPOSE TISSUE METABOLISM IN PREGNANCY: THE LIPOLYTIC EFFECT OF HUMAN PLACENTAL LACTOGEN. BJOG 1978;85:43–6. https://doi.org/10.1111/j.1471-0528.1978.tb15824.x.
[11] Liu Z-X, Kaplowitz N. Role of innate immunity in acetaminophen-induced hepatotoxicity. Expert Opin Drug Metab Toxicol 2006;2:493–503. https://doi.org/10.1517/17425255.2.4.493.
[12] Santoleri D, Titchenell PM. Resolving the Paradox of Hepatic Insulin Resistance. Cell Mol Gastroenterol Hepatol 2019;7:447–56. https://doi.org/10.1016/j.jcmgh.2018.10.016.
[13] Applebaum DM, Goldberg AP, Pykälistö OJ, Brunzell JD, Hazzard WR. Effect of estrogen on post-heparin lipolytic activity. Selective decline in hepatic triglyceride lipase. Journal of Clinical Investigation 1977;59:601–8. https://doi.org/10.1172/JCI108677.
[14] Pecks U, Rath W, Kleine-Eggebrecht N, Maass N, Voigt F, Goecke T, et al. Maternal Serum Lipid, Estradiol, and Progesterone Levels in Pregnancy, and the Impact of Placental and Hepatic Pathologies. Geburtshilfe Frauenheilkd 2016;76:799–808. https://doi.org/10.1055/s-0042-107078.
[15] Duttaroy AK, Basak S. Maternal Fatty Acid Metabolism in Pregnancy and Its Consequences in the Feto-Placental Development. Front Physiol 2022;12. https://doi.org/10.3389/fphys.2021.787848.
[16] International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. Diabetes Care 2010;33:676–82. https://doi.org/10.2337/dc09-1848.
[17] Koukkou E, Watts GF, Lowy C. Serum lipid, lipoprotein and apolipoprotein changes in gestational diabetes mellitus: a cross-sectional and prospective study. J Clin Pathol 1996;49:634–7. https://doi.org/10.1136/jcp.49.8.634.
[18] O’Malley EG, Reynolds CME, Killalea A, O’Kelly R, Sheehan SR, Turner MJ. Maternal obesity and dyslipidemia associated with gestational diabetes mellitus (GDM). European Journal of Obstetrics & Gynecology and Reproductive Biology 2020;246:67–71. https://doi.org/10.1016/j.ejogrb.2020.01.007.
[19] Layton J, Powe C, Allard C, Battista M-C, Doyon M, Bouchard L, et al. Maternal lipid profile differs by gestational diabetes physiologic subtype. Metabolism 2019;91:39–42. https://doi.org/10.1016/j.metabol.2018.11.008.
[20] Ryckman K, Spracklen C, Smith C, Robinson J, Saftlas A. Maternal lipid levels during pregnancy and gestational diabetes: a systematic review and meta-analysis. BJOG 2015;122:643–51. https://doi.org/10.1111/1471-0528.13261.
[21] Qiu C, Rudra C, Austin M, Williams M. Association of gestational diabetes mellitus and low-density lipoprotein (LDL) particle size. Physiol Res 2007:571–8. https://doi.org/10.33549/physiolres.931073.
[22] Ivanova EA, Myasoedova VA, Melnichenko AA, Grechko A V., Orekhov AN. Small Dense Low-Density Lipoprotein as Biomarker for Atherosclerotic Diseases. Oxid Med Cell Longev 2017;2017:1–10. https://doi.org/10.1155/2017/1273042.
[23] Li G, Kong L, Zhang L, Fan L, Su Y, Rose JC, et al. Early Pregnancy Maternal Lipid Profiles and the Risk of Gestational Diabetes Mellitus Stratified for Body Mass Index. Reproductive Sciences 2015;22:712–7. https://doi.org/10.1177/1933719114557896.
[24] Wang J, Li Z, Lin L. Maternal lipid profiles in women with and without gestational diabetes mellitus. Medicine 2019;98:e15320. https://doi.org/10.1097/MD.0000000000015320.
[25] Zhu S-M, Zhang H-Q, Li C, Zhang C, Yu J-L, Wu Y-T, et al. Maternal lipid profile during early pregnancy and birth weight: A retrospective study. Front Endocrinol (Lausanne) 2022;13. https://doi.org/10.3389/fendo.2022.951871.
[26] Capobianco G, Gulotta A, Tupponi G, Dessole F, Pola M, Virdis G, et al. Materno-Fetal and Neonatal Complications of Diabetes in Pregnancy: A Retrospective Study. J Clin Med 2020;9:2707. https://doi.org/10.3390/jcm9092707.
[27] Zheng Y, Hou W, Xiao J, Huang H, Quan W, Chen Y. Application Value of Predictive Model Based on Maternal Coagulation Function and Glycolipid Metabolism Indicators in Early Diagnosis of Gestational Diabetes Mellitus. Front Public Health 2022;10. https://doi.org/10.3389/fpubh.2022.850191.
[28] Kosmas CE, Rodriguez Polanco S, Bousvarou MD, Papakonstantinou EJ, Peña Genao E, Guzman E, et al. The Triglyceride/High-Density Lipoprotein Cholesterol (TG/HDL-C) Ratio as a Risk Marker for Metabolic Syndrome and Cardiovascular Disease. Diagnostics 2023;13:929. https://doi.org/10.3390/diagnostics13050929.
[29] Borrayo G. Tg/Hdl-C Ratio as Cardio-Metabolic Biomarker even in Normal Weight Women. Acta Endocrinologica (Bucharest) 2018;14:261–7. https://doi.org/10.4183/aeb.2018.261.
[30] You Y, Hu H, Cao C, Han Y, Tang J, Zhao W. Association between the triglyceride to high-density lipoprotein cholesterol ratio and the risk of gestational diabetes mellitus: a second analysis based on data from a prospective cohort study. Front Endocrinol (Lausanne) 2023;14. https://doi.org/10.3389/fendo.2023.1153072.
[31] dos Santos-Weiss ICR, Réa RR, Fadel-Picheth CMT, Rego FGM, Pedrosa F de O, Gillery P, et al. The plasma logarithm of the triglyceride/HDL-cholesterol ratio is a predictor of low risk gestational diabetes in early pregnancy. Clinica Chimica Acta 2013;418:1–4. https://doi.org/10.1016/j.cca.2012.12.004.
[32] Wang D, Xu S, Chen H, Zhong L, Wang Z. The associations between triglyceride to high‐density lipoprotein cholesterol ratios and the risks of gestational diabetes mellitus and large‐for‐gestational‐age infant. Clin Endocrinol (Oxf) 2015;83:490–7. https://doi.org/10.1111/cen.12742.
[33] Barat S, Ghanbarpour A, Bouzari Z, Batebi Z. Triglyceride to HDL cholesterol ratio and risk for gestational diabetes and birth of a large-for-gestational-age newborn. Caspian J Intern Med 2018;9:368–75. https://doi.org/10.22088/cjim.9.4.368.
[34] Shen H, Liu X, Chen Y, HE B, Cheng W. Associations of lipid levels during gestation with hypertensive disorders of pregnancy and gestational diabetes mellitus: a prospective longitudinal cohort study. BMJ Open 2016;6:e013509. https://doi.org/10.1136/bmjopen-2016-013509.
[35] Benhalima K, Van Crombrugge P, Moyson C, Verhaeghe J, Vandeginste S, Verlaenen H, et al. Characteristics and pregnancy outcomes across gestational diabetes mellitus subtypes based on insulin resistance. Diabetologia 2019;62:2118–28. https://doi.org/10.1007/s00125-019-4961-7.
[36] Correa PJ, Venegas P, Palmeiro Y, Albers D, Rice G, Roa J, et al. First trimester prediction of gestational diabetes mellitus using plasma biomarkers: a case-control study. J Perinat Med 2019;47:161–8. https://doi.org/10.1515/jpm-2018-0120.
[37] Wu Y-T, Zhang C-J, Mol BW, Kawai A, Li C, Chen L, et al. Early Prediction of Gestational Diabetes Mellitus in the Chinese Population via Advanced Machine Learning. J Clin Endocrinol Metab 2021;106:e1191–205. https://doi.org/10.1210/clinem/dgaa899.
[38] Duarte Lau F, Giugliano RP. Lipoprotein(a) and its Significance in Cardiovascular Disease. JAMA Cardiol 2022;7:760. https://doi.org/10.1001/jamacardio.2022.0987.
[39] O’Malley EG, Reynolds CME, Killalea A, O’Kelly R, Sheehan SR, Turner MJ. Maternal obesity and dyslipidemia associated with gestational diabetes mellitus (GDM). European Journal of Obstetrics & Gynecology and Reproductive Biology 2020;246:67–71. https://doi.org/10.1016/j.ejogrb.2020.01.007.
[40] Bao W, Dar S, Zhu Y, Wu J, Rawal S, Li S, et al. Plasma concentrations of lipids during pregnancy and the risk of gestational diabetes mellitus: A longitudinal study. J Diabetes 2018;10:487–95. https://doi.org/10.1111/1753-0407.12563.
[41] Kumru P, Arisoy R, Erdogdu E, Demirci O, Kavrut M, Ardıc C, et al. Prediction of gestational diabetes mellitus at first trimester in low-risk pregnancies. Taiwan J Obstet Gynecol 2016;55:815–20. https://doi.org/10.1016/j.tjog.2016.04.032.
[42] Cui S, Zhu X, Li S, Zhang C. Study on the predictive value of serum hypersensitive C-reactive protein, homocysteine, fibrinogen, and omentin-1 levels with gestational diabetes mellitus. Gynecological Endocrinology 2023;39. https://doi.org/10.1080/09513590.2023.2183046.
[43] Zou J, Liu Y, Shen J, Xue A, Yan L, Zhang Y. The role of 25(
[44] Lowe LP, Perak AM, Kuang A, Lloyd-Jones DM, Sacks DA, Deerochanawong C, et al. Associations of glycemia and lipid levels in pregnancy with dyslipidemia 10–14 years later: The HAPO follow-up study. Diabetes Res Clin Pract 2022;185:109790. https://doi.org/10.1016/j.diabres.2022.109790.
[45] Pei L, Xiao H, Lai F, Li Z, Li Z, Yue S, et al. Early postpartum dyslipidemia and its potential predictors during pregnancy in women with a history of gestational diabetes mellitus. Lipids Health Dis 2020;19:220. https://doi.org/10.1186/s12944-020-01398-1.
[46] Diaz-Santana M V., O’Brien KM, Park Y-MM, Sandler DP, Weinberg CR. Persistence of Risk for Type 2 Diabetes After Gestational Diabetes Mellitus. Diabetes Care 2022;45:864–70. https://doi.org/10.2337/dc21-1430.
Published
2025/10/30
Section
Mini pregledni članak