Final Report Summary - PREDICT (EVALUATION OF LIPID LEVELS PRIOR AND DURING GESTATION AND ASSOCIATION WITH ADVERSE PREGNANCY OUTCOMES AND SUBSEQUENT DEVELOPMENT OF TRUE DYSLIPIDEMIA. POPULATION BASED STUDY.)
Several components of the metabolic syndrome are known risk factors for (or are associated with) development of pregnancy complications. The manifestations of the metabolic syndrome (obesity, insulin resistance and hypertriglyceridemia) are major contributors to the development of endothelial dysfunction, which in turn, is central in the pathogenesis of preeclampsia.
The additional component of the metabolic syndrome, dyslipidemia, is expressed by elevated triglycerides and/or low HDL and is a well known cardiovascular risk factor. However lipid physiology and pathophysiology during pregnancy has not been studied extensively in large population-based cohorts.
In a previous studies we have shown that: a) lipids level variations during pregnancy are characterized by an initial decrease with nadir during first trimester followed by the gradual increase and a peak before the delivery (fig 1); b) high levels of triglycerides during pregnancy are associated with an increased risk for preeclampsia and gestational diabetes mellitus; c) women with preeclampsia and gestational diabetes continue to have higher levels of triglycerides, total cholesterol and LDL during first postpartum year.
In the current retrospective study we included all singleton deliveries (n = 27,721) of women without known cardiovascular morbidity and preeclampsia and gestational diabetes mellitus during previous pregnancies. Association between preconception low high density lipoprotein cholesterol (HDLc level≤50 mg/dL), high triglycerides (level≥150 mg/dL) and the primary outcome (composite of gestational diabetes mellitus/or preeclampsia) was assessed using Generalized Estimation Equations (GEE).
Primary outcome of preeclampsia and/or gestational diabetes was observed in a total of 3,243 subjects (11.7%). Elevated triglycerides and low HDLc were independently associated with the primary outcome: with odds ratio (OR) of 1.61 (95% CI 1.29–2.01) and OR = 1.33 (95% CI 1.09–1.63) respectively, after adjusting for maternal age, weight, blood pressure, repeated abortions, fertility treatments and fasting glucose. There was an interaction between the effects of HDLc≤50 mg/dL and triglycerides≥150 mg/dL with an OR of 2.69 (95% CI 1.73–4.19).
Our analysis showed an increased rate of preeclampsia and/or gestational diabetes in women with low HDLc and high triglycerides values prior to conception. In view of the severity of these pregnancy complications, we believe this finding warrants a routine screening for the abnormal lipid profile among women of a child-bearing age.
The additional component of the metabolic syndrome, dyslipidemia, is expressed by elevated triglycerides and/or low HDL and is a well known cardiovascular risk factor. However lipid physiology and pathophysiology during pregnancy has not been studied extensively in large population-based cohorts.
In a previous studies we have shown that: a) lipids level variations during pregnancy are characterized by an initial decrease with nadir during first trimester followed by the gradual increase and a peak before the delivery (fig 1); b) high levels of triglycerides during pregnancy are associated with an increased risk for preeclampsia and gestational diabetes mellitus; c) women with preeclampsia and gestational diabetes continue to have higher levels of triglycerides, total cholesterol and LDL during first postpartum year.
In the current retrospective study we included all singleton deliveries (n = 27,721) of women without known cardiovascular morbidity and preeclampsia and gestational diabetes mellitus during previous pregnancies. Association between preconception low high density lipoprotein cholesterol (HDLc level≤50 mg/dL), high triglycerides (level≥150 mg/dL) and the primary outcome (composite of gestational diabetes mellitus/or preeclampsia) was assessed using Generalized Estimation Equations (GEE).
Primary outcome of preeclampsia and/or gestational diabetes was observed in a total of 3,243 subjects (11.7%). Elevated triglycerides and low HDLc were independently associated with the primary outcome: with odds ratio (OR) of 1.61 (95% CI 1.29–2.01) and OR = 1.33 (95% CI 1.09–1.63) respectively, after adjusting for maternal age, weight, blood pressure, repeated abortions, fertility treatments and fasting glucose. There was an interaction between the effects of HDLc≤50 mg/dL and triglycerides≥150 mg/dL with an OR of 2.69 (95% CI 1.73–4.19).
Our analysis showed an increased rate of preeclampsia and/or gestational diabetes in women with low HDLc and high triglycerides values prior to conception. In view of the severity of these pregnancy complications, we believe this finding warrants a routine screening for the abnormal lipid profile among women of a child-bearing age.