Menoufia Medical Journal

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 33  |  Issue : 3  |  Page : 830--834

Pattern of lipid profile in pregnancy and its impact on the gestational course


Ashraf Reda1, Awni Gamal1, Mohamed Rezk2, Gehad Gamal3, Ommaima Idris4, Marwa Sharaf4,  
1 Department of Cardiology, Faculty of Medicine, Menoufia University, Menoufia Governorate, Egypt
2 Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia Governorate, Egypt
3 Department of Cardiology at Dar Alfouad Hospital, Giza, Egypt
4 Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo Governorate, Egypt

Correspondence Address:
Gehad Gamal
377 L Ahram Gardens, 6th October City, Cairo Governorate
Egypt

Abstract

Objective The aim was to screen lipid profile in pregnancy and assess the association between second trimester maternal lipid profile and gestational outcome. Background Major changes in lipid profile occur during normal pregnancy and significant association with gestational complications could be confirmed. Materials and methods This cohort study included 94 women with maternal lipid profile assessed during the second trimester (16–18 weeks). Serial antenatal visits were conducted to record the development of maternal gestational hypertension (GH), preeclampsia (PE), gestational diabetes mellitus (GDM), and low birth weight. Results Lipid profile components in pregnancy are higher than normal references. Meanwhile, GH was the most common complication in the study affecting 13 (13.8%) patients followed by PE in eight (8.5%) patients, GDM in seven (7.4%) patients, and lastly low birth weight in four (4.3%) neonates. A positive association between second trimester lipid profile components and GH, PE, and GDM was found. Conclusion Lipid profile during the second trimester should be done routinely especially in patients with hypertensive disorders and GDM.



How to cite this article:
Reda A, Gamal A, Rezk M, Gamal G, Idris O, Sharaf M. Pattern of lipid profile in pregnancy and its impact on the gestational course.Menoufia Med J 2020;33:830-834


How to cite this URL:
Reda A, Gamal A, Rezk M, Gamal G, Idris O, Sharaf M. Pattern of lipid profile in pregnancy and its impact on the gestational course. Menoufia Med J [serial online] 2020 [cited 2021 Jan 20 ];33:830-834
Available from: http://www.mmj.eg.net/text.asp?2020/33/3/830/296663


Full Text



 Introduction



Major changes in lipid profile occur during normal pregnancy with progressive increase in maternal plasma cholesterol and triglyceride (TG) levels during the late second and the third trimester, returning to normal after delivery [1],[2],[3],[4].

Pregnancy-associated hyperlipidemia was linked with maternal morbidity with the development of gestational diabetes mellitus (GDM) and preeclampsia (PE) [5],[6],[7].

To the authors' knowledge, there were no studies in the literature addressing lipid profile in pregnant women in Egypt.

We aimed to assess the association between second trimester maternal lipid profile and adverse pregnancy outcome among a cohort of Egyptian pregnant women.

 Materials and Methods



This prospective study was conducted at the Department of Cardiology in collaboration with the Obstetrics and Gynecology Department, Menoufia University Hospital, Menoufia Governorate, Egypt, during the period between June 2016 and June 2018.

The study protocol was formally reviewed and approved by the ethics committee for human research at the Menoufia Faculty of Medicine with informed consent obtained from all participants prior to start of the study after thorough explanation of the study objectives.

Pregnant women attending the antenatal care clinic at Menoufia University Hospital during early first trimester at 6–12 weeks' gestation were invited to participate. Gestational age was based on the date of last menstrual period together with early obstetric ultrasound scan.

Women with medical disorders, such as diabetes mellitus and hypertension, multiple pregnancy, congenital fetal malformations, interrupted pregnancy (whether spontaneous or induced abortion) as well as drug intake affecting lipid profile, were excluded from the study.

After exclusion of nonresponders, dropout participants and those with exclusion criteria, 94 women completed the study (this number was considered suitable enough sample for statistical analysis with significant results and correlations).

Blood samples were drawn from all the subjects following a fast of 12 h at 16–18 weeks' gestation and analyzed for serum TG, total cholesterol (TC), low-density lipoprotein (LDL) cholesterol (LDL-C), and high-density lipoprotein (HDL) cholesterol (HDL-C) by enzymatic methods of analysis using an autoanalyzer.

The participants were followed up at the antenatal care clinic throughout pregnancy with frequency of visits of five visits and delivered at the Menoufia University Hospital to record the neonatal outcome.

Outcome measures

Maternal outcome: development of gestational hypertension (GH) (elevation of blood pressure ≥140/90 mmHg after 20 weeks' gestation on two occasions with 4-h apart after rest)PE (a new-onset hypertension associated with new-onset proteinuria of ≥0.3 g protein in 24-h urine collection or urinary dipsticks ≥1+)GDM (elevated ≥2 values after performing a 75 g, 2-h oral glucose tolerance test)Fetal and neonatal outcome: low birth weight, defined as a birth weight less than 2500 g.

The authors addressed only these complications secondary to their major impact on obstetric outcome.

Statistical analysis

Statistical analysis was performed using the statistical package for the social sciences Version 22 (IBM Corp., Armonk, New York, USA). Quantitative data are expressed as means and SD.

A P value less than or equal to 0.05 was considered to indicate significance. Correlation analysis assesses the strength of association between two variables. Multiple logistic regression analysis was used to detect the associations between lipid profile and both maternal and neonatal complications.

 Results



Maternal demographic data including age, weight, height, BMI, baseline systolic, and diastolic blood pressure and then maternal lipid profile in relation to the normal range are depicted in [Table 1].{Table 1}

Regarding the mean value of lipid profile components in pregnancy: cholesterol 249 mg/dl (reference normal value 200 mg/dl) HDL 67 md/dl (reference normal value >50 mg/dl), LDL 137 mg/dl (reference normal value 130 mg/dl), and TG 220 mg/dl (reference normal value 150 mg/dl).

Meanwhile, the mean percent difference from the reference normal values of the lipid profile were: cholesterol % difference 24.5, HDL % difference 34.5, LDL % difference 5.5, and TG % difference 46.9.

GH was the most common complication in the study affecting 13 (13.8%) patients followed by PE in eight (8.5%) patients, GDM in seven (7.4%) patients, and lastly low birth weight in four (4.3%) neonates [Figure 1].{Figure 1}

There is a significant positive correlation between TC and both age and systolic blood pressure (SBP) in all patients (P = 0.04 and 0.003, respectively).

Meanwhile, there is significant positive correlation between LDL level and SBP (P = 0.009).

Also, there is significant positive correlation between TG and both age and BMI (P = 0.006 and 0.01, respectively).

Mean percent difference of TC from the reference normal values in patients who developed GDM were significantly higher than those without GDM: 44% (vs. 23% in those without GDM) (P = 0.044) [Figure 2]. Also, there was a significant increase in LDL (31%) (vs. 3% in those without GDM) (P = 0.049). However, there was insignificant change in HDL and TG during pregnancy.{Figure 2}

We speculated the mean percent difference of TC in patients who developed pregnancy-induced HTN (PIH) were significantly higher than those without PIH: cholesterol 46% (21% in those without HTN) (P = 0.0001) [Figure 3]. Also, there is a significant increase in LDL (33%) (vs. 1.1% in those without HTN) and TG (74%) (vs. 42% in those without HTN) (P = 0.004 and 0.029, respectively). However, it was an insignificant change in HDL.{Figure 3}

We showed that a mean percent difference of lipid profile in patients who developed PE were significantly higher than those without: TC 48% (vs. 23% in those without PE) (P = 0.003) [Figure 4]. Also, there was a significant increase in LDL (41%) (vs. 2.2% in those without PE) (P = 0.006), while insignificant change in TG and HDL were detected.{Figure 4}

 Discussion



Our study was conducted at the Department of Cardiology in collaboration with the Obstetrics and Gynecology Department, Menoufia University Hospital, Menoufia Governorate, Egypt, during the period between June 2016 and June 2018, after being reviewed and approved by the ethics committee for human research. Pregnant women attending the antenatal clinic during the early first trimester at 6–12 weeks' gestation were invited to participate in the study.

The current study confirmed the previous associations between altered maternal lipid profile components and adverse maternal and fetal outcomes.

Second trimester elevated TC and LDL were found in women who developed GDM. In addition, TC, TG, and LDL were elevated in those developing GH, while elevated TC and LDL were found in patients with PE.

Maternal plasma lipids climb substantially above levels seen in normal pregnancies in women who developed PE or intrauterine fetal growth restriction without maternal systemic manifestations of hypertension and proteinuria [8].

A previous larger cohort study included 4008 nondiabetic women with early maternal lipid profile measured during early gestation (12–14 weeks) to detect the association between lipid profile and PIH, PE, preterm birth, small/large for gestational age (SGA/LGA), and child loss, who had shown that every unit increase in TG was linearly associated with an increased risk of PIH [odds ratio (OR)=1.60, P = 0.021], PE (OR = 1.69, P = 0.018), LGA (OR = 1.48, P < 0.001), and induced preterm delivery (OR = 1.69, P = 0.006), while TC was not associated with any of the outcome measures [9].

A more recent population-based study from China including 934 pairs of nondiabetic mothers and neonates between 2010 and 2011 with maternal lipid profile measured during the first, second, and third trimesters had shown that maternal high TG in late pregnancy was independently associated with increased risk of GDM, PE, intrahepatic cholestasis of pregnancy and neonatal macrosomia [10].

Another recent prospective longitudinal cohort study that included 1310 eligible women with maternal lipid profile assessed in the first, second, and third trimesters consecutively showed that repeated TG levels could be used as follow-up parameters during complicated pregnancy, while other lipids are meaningful only in the first trimester [11].

Even though, prepregnancy altered maternal lipid profile was associated with subsequent development of GDM as depicted in a recent nested case–control study [12].

Bharathi [13] et al. tested the lipid profile in 100 Indian pregnant women showed that serum TG, TC, and VLDL levels are significantly higher among women with GDM compared with non-GDM pregnant women.

Our results were concordant with those of Chandi et al. [14], who recognized an association of maternal hypertriglyceridemia with PIH. Among 59 women, a significant positive correlation was found between serum TG concentration and SBP. Also, mothers with hypertriglyceridemia were found to be at higher risk of developing early-onset gestational HTN [14].

Onuegbu et al. [15] have evaluated the serum lipid profile and C-reactive protein in 35 Nigerian women with PE and indicated that women with PE had significantly higher mean serum C-reactive protein (P = 0.001), TG (P = 0.001), and TC (P = 0.001) level, but lower mean HDL-C (P = 0.001) levels than the controls.

From all these data, lifestyle modifications for women during the reproductive years should focus on lowering maternal TG levels through diet, weight reduction, and physical activity that may help in decreasing the maternal complications during pregnancy including GDM and hypertensive disorders with their deleterious impact on obstetric outcomes [9].

The inability to measure maternal lipid profile during the three trimesters secondary to their high cost as well as to include a larger cohort was the unintended limitations of the current study.

Future research should explore the implementation of maternal lipid profile and lifestyle modifications for the prevention of hypertensive disorders during pregnancy and other adverse outcome.

In conclusion, measurement of lipid profile during the second trimester could be done routinely especially in patients with hypertensive disorders in pregnancy and GDM among Egyptian women. Moreover, lifestyle modifications are required to prevent complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Lippi G, Albiero A, Montagnana M, Salvagno GL, Scevarolli S, Franchi M, Guidi GC. Lipid and lipoprotein profile in physiological pregnancy. Clin Lab 2007; 53:173–177.
2Husain F, Latif S, Uddin M, Nessa A. Lipid profile changes in second trimester of pregnancy. My Mensingh Med J 2008; 17:17–21.
3Potter JM, Nestel PJ. the hyperlipidemia of pregnancy in normal and complicated pregnancies. Am J obstet Gynecol 1979; 133:165–170.
4Bartels č, Egan N, Broadhurst DI, Khashan AS, Joyce C, Stapleton M, et al. Maternal serum cholesterol levels are elevated from the 1st trimester of pregnancy: A cross-sectional study. J Obstet Gynaecol 2012; 32:747–752.
5Koukkou 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; 49:634–637.
6Wiznitzer A, Mayer A, Novack V, Sheiner E, Gilutz H, Malhotra A, Novack L. Association of lipid levels during gestation with preeclampsia and gestational diabetes mellitus: a population-based study. Am J Obstet Gynecol 2009; 201:482.
7Ferriols E, Rueda C, Gamero R, Vidal M, Payá A, Carreras R, et al. Relationship between lipid alterations during pregnancy and adverse pregnancy outcomes. Clin Investig Arterioscler 2016; 28:232–244.
8Sattar N, Greer IA, Galloway PJ, Packard CJ, Shepherd J, Kelly T, Mathers A. Lipid and lipoprotein concentrations in pregnancies complicated by intrauterine growth restriction. J Clin Endocrinol Metab 1999; 84:128–130.
9Vrijkotte TG, Krukziener N, Hutten BA, Vollebregt KC, van Eijsden M, Twickler MB. Maternal lipid profile during early pregnancy and pregnancy complications and outcomes: the ABCD study. J Clin Endocrinol Metab 2012; 97:3917–3925.
10Jin WY, Lin SL, Hou RL, Chen XY, Han T, Jin Y, Tang L, et al. Associations between maternal lipid profile and pregnancy complications and perinatal outcomes: a population-based study from China. BMC Pregnancy Childbirth 2016; 16:60.
11Shen 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:e 013509.
12Han ES, Krauss RM, Xu F, Sridhar SB, Ferrara A, Quesenberry CP, Hedderson MM. Pre pregnancy adverse lipid profile and subsequent risk of gestational diabetes. J Clin Endocrinol Metab 2016; 101:2721–2727.
13Bharathi KR, Vijayalakshmi S, Shrunga RP. A study of lipid parameters among GDM and non GDM pregnant women: a hospital based study. Int J Reprod Contracept Obstet Gynecol 2017; 6:5488–5490.
14Chandi A, Sirohiwal D, Malik R. Association of early maternal hypertriglyceridemia with pregnancy-induced hypertension. Arch Gynecol Obstet 2015; 292:1135–1143.
15Onuegbu AJ, Olisekodiaka JM, Udo JU, Umeononihu O, Amah UK, Okwara JE, et al. Evaluation of high-sensitivity c-reactive protein and serum lipid profile in Southeastern Nigerian women with pre-eclampsia Departments of a Chemical Pathology and Obstetrics and Gynecology, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria. Med Princ Pract 2015; 24:276–279.