Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-08-16 Cooperative journals: 《中国全科医学》
Abstract： Background Elevated dyslipidemia during pregnancy can adversely affect maternal and child health. It not only increases the risk of preeclampsia，gestational diabetes mellitus（GDM），hypertriglyceridemic pancreatitis，late abortion，premature delivery and macrosomia，but also significantly increases the risk of postnatal cardiovascular disease. Objective To analyze the distributional characteristics of dyslipidemia in the first，second and third trimesters of pregnancy and the predictive value of early lipid levels for dyslipidemia in the second and third trimesters of pregnancy. Methods This was a single-center retrospective study，which included singleton pregnant women who were enrolled in Beijing Obstetrics and Gynecology Hospital，Capital Medical University from January 2018 to June 2019 for obstetrics checkups until delivery. Clinical data and lipid data〔total cholesterol（TC），triacylglycerol（TG），low-density lipoprotein cholesterol（LDL-C），and high-density lipoprotein cholesterol（HDL-C）〕were collected in the first，second and third trimesters of pregnancy. The reference range of lipids in department of obstetrics，Beijing Obstetrics and Gynecology Hospital，Capital Medical University was used as the diagnostic standard for dyslipidemia，including high total cholesterolemia，high triacylglycerolemia，low HDL-cholesterolemia and high LDL-cholesterolemia. The correlation between lipid levels in the first trimester of pregnancy and dyslipidemia in the second and third trimesters of pregnancy was analyzed by using binary Logistic regression，and the receiver operating characteristics（ROC）curves of the subjects were plotted to obtain the area under ROC curve（AUC），to evaluate the predictive value of the lipid levels in the first trimester of pregnancy for dyslipidemia in the second and third trimesters of pregnancy，and to determine the optimal cut-off value according to the sensitivity and specificity. Results A total of 8 511 singleton pregnant women were included in the study，with an average age of（31.7±3.9）years and an average pre pregnancy BMI of（21.7±3.2）kg/m2 . Among them，988（11.6%）were of low pre-pregnancy body mass，5 568（65.4%）were of normal pre-pregnancy body mass，1 271（14.9%）were overweight，366（4.3%）were obese，1 415（16.7%） were with GDM，and 650（7.6%）were with hypertensive disorders of pregnancy（HDP）. The levels of TC，TG and LDL-C in the second and third trimesters of pregnancy were higher than those in the first trimester of pregnancy（P<0.05）. The level of HDL-C in the third trimester of pregnancy was higher than that in the first trimester of pregnancy，but lower than that in the second trimester of pregnancy（P<0.05）. The prevalence of dyslipidemia in the first trimester of pregnancy was 23.4%（1990/8511），and the prevalence of dyslipidemia in the second and third trimesters of pregnancy was lower than that in the first trimester of pregnancy（P<0.05）. The prevalence of dyslipidemia in overweight and obese pregnant women in the first trimester of pregnancy was higher than that in pregnant women with normal pre-pregnancy body mass，but there was no statistical difference in the prevalence of dyslipidemia in the third trimester of pregnancy（P>0.05）. The prevalence of dyslipidemia in first and second trimesters of pregnancy in the GDM group was higher than that in the non-GDM group，and the prevalence of dyslipidemia in first，second and third trimesters of pregnancy in HDP group was higher than the non-HDP group（P<0.05）. After excluding pregnancy comorbidities and complications that may affect blood lipids，the optimal cut-off values for predicting dyslipidemia in the second trimester of pregnancy were TC of 4.485 mmol/L（AUC=0.854），TG of 1.325 mmo/L（AUC=0.864），HDL-C of 1.275 mmol/L（AUC=0.908），and LDL-C of 2.265 mmol/L（AUC=0.823），respectively；the optimal cut-off values for predicting dyslipidemia in the third trimester of pregnancy were TC of 4.485 mmol/L（AUC=0.809），TG of 1.145 mmol/L（AUC=0.833），HDL-C of 1.285 mmol/L（AUC=0.851），LDL-C of 2.195 mmol/L（AUC=0.766）. Conclusion The prevalence of dyslipidemia did not increase during pregnancy. There were significant differences in the prevalence of dyslipidemia during pregnancy among pregnant women with different pre-pregnancy BMI，between GDM and non-GDM pregnant women，between HDP and non-HDP pregnant women，respectively. The blood lipid level in the first trimester was helpful to predict the occurrence of dyslipidemia in the second and third trimesters of pregnancy.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-04-03 Cooperative journals: 《中国全科医学》
Abstract： Background Macrosomia is not only harmful to the pregnant women and newborns，but also to the long-term metabolic health of the offspring. Maternal body mass is closely associated with pregnancy outcomes，overweight and obese pregnant women are often associated with dyslipidemia，while elevated blood lipid levels during pregnancy can affect the intrauterine environment and neonatal birth weight has not been investigated. Objective To analyze the association between blood lipid levels and macrosomia in pregnant women with different pre-pregnancy body mass index（BMI）. Methods A total of 5 287 singleton pregnant women who were registered at department of obstetrics of Beijing Obstetrics and Gynecology Hospital，Capital Medical University until delivery from January 2018 to June 2019 and met the inclusion and exclusion criteria were included in the single-center retrospective study，and divided into low-body-mass pregnant women with a non-macrosomia group （group A， n=731） and with a macrosomia group（group B， n=27），normal-body-mass pregnant women with a nonmacrosomia group（group C， n=3 539） and with a macrosomia group （group D， n=243），overweight and obese pregnant women with a non-macrosomia group（group E， n=675）and with a macrosomia group（group F， n=72） according to maternal pre-pregnancy BMI and neonatal birth weight. Relevant clinical and laboratory data of pregnant women were collected for statistical analysis. Binary Logistic regression analysis was used to explore the association between blood lipid levels and macrosomia in pregnant women with different pre-pregnancy BMI. Results The level of high-density lipoprotein cholesterol （HDL-C） in the third trimester of pregnancy in group B was lower than group A（ P<0.05）. The levels of total cholesterol（TC）in the first trimester and triglyceride（TG） in the third trimester in group D were higher than group C（ P<0.05），while the levels of HDL-C in the second and third trimesters were lower than group C（ P<0.05）. The TG levels in the first，second and third trimesters of pregnancy in group F were higher than group E（ P<0.05），while HDL-C levels in the second and third trimesters were lower than group E（ P<0.05）. Binary Logistic regression analysis showed that HDL-C level in the third trimester〔 OR=0.256，95%CI （0.075，0.871）〕 was the influencing factor of macrosomia in low body mass pre-pregnancy women（ P<0.05）.HDL-C levels in the second and third trimesters〔 OR=0.661，95%CI（0.450，0.971）； OR=0.406，95%CI（0.271，0.610）〕were the influencing factors of macrosomia in normal body mass pre-pregnancy women（ P<0.05）. TG levels in the first，second and third trimesters〔 OR=1.546，95%CI（1.070，2.234）； OR=1.399，95%CI（1.019，1.758）； OR=1.289，95%CI（1.072，1.550）〕 were the influencing factors of macrosomia in overweight and obese pre-pregnancy women（ P<0.05）. Conclusion For pre-pregnancy women with low and normal body mass，low HDL-C level during pregnancy is associated with an increased risk for macrosomia，while for overweight and obese pre-pregnancy women，high TG level during pregnancy is associated with an increased risk of macrosomia. For pregnant women with large fetuses or high risk of macrosomia during maternal examination，it is necessary to emphasize the detection and control of blood lipid levels.
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