The role of dyslipidemia in the pathogenesis of perinatal complications in pregnant women with diabetes mellitus

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HYPOTHESIS/AIMS OF STUDY: The prevalence of diabetes mellitus in pregnant women is increasing. Physiological hyperlipidemia is usually developed during the last third of gestation, increases during pregnancies complicated by diabetes mellitus. Abnormal lipid profiles are associated with adverse perinatal outcomes. However, the associations between maternal dyslipidemia and pregnancy complications in women with different diabetes mellitus types remain unclear. The aim of this study was to assess the lipid profile in women with different types of diabetes mellitus (Type 1, Type 2, and gestational diabetes) based on the therapy in the third trimester of pregnancy, to investigate the associations between serum lipid profile and perinatal complications, and to determine possible prognostic value of lipids in the development of adverse pregnancy outcomes.

STUDY DESIGN, MATERIALS AND METHODS: The study included 277 women who were divided into several groups depending on the type of diabetes mellitus and its therapy method, a group of patients with preeclampsia, and the control group. We analyzed the clinical and laboratory data of outpatient and inpatient cards of pregnant women in the period between 2010 and 2017. Maternal blood samples were collected between 28 and 32 weeks of gestation. The samples were assayed for fasting triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and very-low-density lipoprotein cholesterol concentrations, as well as the atherogenic index of plasma. We also assessed the incidence of gestational arterial hypertension, preeclampsia, intrauterine growth restriction, and preterm birth.

RESULTS: Pregnant women with various types of diabetes mellitus were characterized by a significant rise in serum triglycerides and very-low-density lipoprotein cholesterol levels, an increase in the atherogenic index of plasma, and a significant decrease in antiatherogenic, high-density lipoprotein cholesterol levels. These changes were most pronounced in pregnant women with pregestational diabetes mellitus types and in groups receiving insulin therapy. Correlation analysis revealed weak positive correlations between serum triglycerides concentrations and macrosomia (r = 0.26) and between the atherogenic index of plasma and severe preeclampsia (r = 0.26). The analysis of the ROC curve showed that triglycerides, very-low-density lipoprotein cholesterol, and the atherogenic index of plasma are predictors of severe preeclampsia.

CONCLUSION: Diabetic pregnancies are associated with increased dyslipidemia, which plays an essential role in the pathogenesis of perinatal complications. Evaluating lipid profile markers in the third trimester of diabetic pregnancy may be valid predictors of severe preeclampsia.

作者简介

Roman Kapustin

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; Saint Petersburg State University

编辑信件的主要联系方式.
Email: kapustin.roman@gmail.com
ORCID iD: 0000-0002-2783-3032
SPIN 代码: 7300-6260
Researcher ID: G-3759-2015

MD, PhD, Secretary Scientific, obstetrician-gynecologist

俄罗斯联邦, Saint Petersburg

Elizaveta Tsybuk

Saint Petersburg State University

Email: elizavetatcybuk@gmail.com
ORCID iD: 0000-0001-5803-1668
SPIN 代码: 3466-7910
Researcher ID: ABB-6930-2020

medical student

俄罗斯联邦, Saint Petersburg

Elena Alexeyenkova

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott

Email: ealekseva@gmail.com
ORCID iD: 0000-0003-1409-5680
SPIN 代码: 3976-2540
Researcher ID: W-3735-2017

Junior Researcher of the Department of Obstetrics and Perinatology

俄罗斯联邦, Saint Petersburg

Ekaterina Kopteyeva

Saint Petersburg State University

Email: ekaterina_kopteeva@bk.ru
ORCID iD: 0000-0002-9328-8909
SPIN 代码: 9421-6407

Clinical Resident of the Department of Obstetrics, Gynecology and Reproductology

俄罗斯联邦, Saint Petersburg

Olga Arzhanova

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; Saint Petersburg State University

Email: olga_arjanova@mail.ru
ORCID iD: 0000-0003-3059-9811
SPIN 代码: 7910-6039
Researcher ID: G-6895-2015

MD, PhD, DSci (Medicine),Professor, Honoured Doctor of the Russian Federation

俄罗斯联邦, Saint Petersburg

Tatyana Oparina

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott

Email: oparinat@mail.ru
ORCID iD: 0000-0001-5133-2396
SPIN 代码: 2719-5432

PhD, Senior Researcher, Laboratory of biochemistry

俄罗斯联邦, Saint Petersburg

Zhanna Tumasova

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott

Email: iagmail@ott.ru

laboratory doctor

俄罗斯联邦, Saint Petersburg

参考

  1. Hod M, Kapur A, Sacks DA, et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus. A pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet. 2015;131 Suppl. 3:S173-S211. doi: 10.1016/S0020-7292(15)30033-3
  2. International Diabetes Federation. [Internet]. IDF Diabetes Atlas, 9th ed. Brussels, 2019 [cited 2021 Jan 19]. Available from: https://diabetesatlas.org/en/
  3. Wang C, Zhu W, Wei Y, et al. The associations between early pregnancy lipid profiles and pregnancy outcomes. J Perinatol. 2017;37(2):127–133. doi: 10.1038/jp.2016.191
  4. Herrera E, Ortega-Senovilla H. Implications of lipids in neonatal body weight and fat mass in gestational diabetic mothers and non-diabetic controls. Curr Diab Rep. 2018;18(2):7. doi: 10.1007/s11892-018-0978-4
  5. Toescu V, Nuttall SL, Martin U, et al. Oxidative stress and normal pregnancy. Clin Endocrinol (Oxf). 2002;57(5):609–613. doi: 10.1046/j.1365-2265.2002.01638.x
  6. Herrera E, Ortega-Senovilla H. Lipid metabolism during pregnancy and its implications for fetal growth. Curr Pharm Biotechnol. 2014;15(1):24–31. doi: 10.2174/1389201015666140330192345
  7. El Khouly NI, Sanad ZF, Saleh SA, et al. Value of first-trimester serum lipid profile in early prediction of preeclampsia and its severity: A prospective cohort study. Hypertens Pregnancy. 2016;35(1):73–81. doi: 10.3109/10641955.2015.1115060
  8. Catov JM, Bodnar LM, Kip KE, et al. Early pregnancy lipid concentrations and spontaneous preterm birth. Am J Obstet Gynecol. 2007;197(6):610.e1–610.e7. doi: 10.1016/j.ajog.2007.04.024
  9. Jin WY, Lin SL, Hou RL, et al. Associations between maternal lipid profile and pregnancy complications and perinatal outcomes: a population-based study from China. BMC Pregnancy Childbirth. 2016;16(1):60. doi: 10.1186/s12884-016-0852-9
  10. Wang X, Guan Q, Zhao J, et al. Association of maternal serum lipids at late gestation with the risk of neonatal macrosomia in women without diabetes mellitus. Lipids Health Dis. 2018;17(1):78. doi: 10.1186/s12944-018-0707-7
  11. Misra VK, Trudeau S, Perni U. Maternal serum lipids during pregnancy and infant birth weight: the influence of prepregnancy BMI. Obesity (Silver Spring). 2011;19(7):1476–1481. doi: 10.1038/oby.2011.43
  12. Mudd LM, Holzman CB, Evans RW. Maternal mid-pregnancy lipids and birthweight. Acta Obstet Gynecol Scand. 2015;94(8):852–860. doi: 10.1111/aogs.12665
  13. Son GH, Kwon JY, Kim YH, Park YW. Maternal serum triglycerides as predictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus. Acta Obstet Gynecol Scand. 2010;89(5):700–704. doi: 10.3109/00016341003605677
  14. Lindegaard ML, Damm P, Mathiesen ER, Nielsen LB. Placental triglyceride accumulation in maternal type 1 diabetes is associated with increased lipase gene expression. J Lipid Res. 2006;47(11):2581–2588. doi: 10.1194/jlr.M600236-JLR200
  15. Ortega-Senovilla H, Schaefer-Graf U, Meitzner K, et al. Decreased concentrations of the lipoprotein lipase inhibitor angiopoietin-like protein 4 and increased serum triacylglycerol are associated with increased neonatal fat mass in pregnant women with gestational diabetes mellitus. J Clin Endocrinol Metab. 2013;98(8):3430–3437. doi: 10.1210/jc.2013–1614
  16. Ryckman KK, Spracklen CN, Smith CJ, et al. Maternal lipid levels during pregnancy and gestational diabetes: a systema-tic review and meta-analysis. BJOG. 2015;122(5):643–651. doi: 10.1111/1471-0528.13261
  17. Toescu V, Nuttall SL, Martin U, et al. Changes in plasma lipids and markers of oxidative stress in normal pregnancy and pregnancies complicated by diabetes. Clin Sci (Lond). 2004;106(1):93–98. doi: 10.1042/CS20030175
  18. Rizzo M, Berneis K, Altinova AE, et al. Atherogenic lipoprotein phenotype and LDL size and subclasses in women with gestational diabetes. Diabet Med. 2008;25(12):1406–1411. doi: 10.1111/j.1464-5491.2008.02613.x
  19. Schaefer-Graf UM, Graf K, Kulbacka I, et al. Maternal lipids as strong determinants of fetal environment and growth in pregnancies with gestational diabetes mellitus. Diabetes Care. 2008;31(9):1858–1863. doi: 10.2337/dc08-0039
  20. Basu A, Alaupovic P, Wu M, et al. Plasma lipoproteins and preeclampsia in women with type 1 diabetes: a prospective study. J Clin Endocrinol Metab. 2012;97(5):1752–1762. doi: 10.1210/jc.2011-3255
  21. Metzger BE, Gabbe SG, Persson B, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676–682. doi: 10.2337/dc09-1848
  22. Göbl CS, Handisurya A, Klein K, et al. Changes in serum lipid levels during pregnancy in type 1 and type 2 diabetic subjects. Diabetes Care. 2010;33(9):2071–2073. doi: 10.2337/dc10-0484
  23. Olmos PR, Borzone GR. Basal-bolus insulin therapy reduces maternal triglycerides in gestational diabetes without modifying cholesteryl ester transfer protein activity. J Obstet Gynaecol Res. 2017;43(9):1397–1404. doi: 10.1111/jog.13403
  24. Retnakaran R, Ye C, Hanley AJ, et al. Effect of maternal weight, adipokines, glucose intolerance and lipids on infant birth weight among women without gestational diabetes mellitus. CMAJ. 2012;184(12):1353–1360. doi: 10.1503/cmaj.111154
  25. Sommer C, Sletner L, Mørkrid K, et al. Effects of early pregnancy BMI, mid-gestational weight gain, glucose and lipid levels in pregnancy on offspring’s birth weight and subcutaneous fat: a population-based cohort study. BMC Pregnancy Childbirth. 2015;15:84. doi: 10.1186/s12884-015-0512-5
  26. Szabo AJ. Transferred maternal fatty acids stimulate fetal adipogenesis and lead to neonatal and adult obesity. Med Hypotheses. 2019;122:82–88. doi: 10.1016/j.mehy.2018.10.022
  27. Simeonova-Krstevska S, Krstevska B, Velkoska-Nakova V, et al. Effect of lipid parameters on foetal growth in gestational diabetes mellitus pregnancies. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2014;35(2):131–136. doi: 10.2478/prilozi-2014-0017
  28. Olmos PR, Rigotti A, Busso D, et al. Maternal hypertriglyceridemia: A link between maternal overweight-obesity and macrosomia in gestational diabetes. Obesity (Silver Spring). 2014;22(10):2156–2163. doi: 10.1002/oby.20816
  29. Krstevska B, Jovanovska SM, Krstevska SS, et al. Maternal lipids may predict fetal growth in type 2 diabetes mellitus and gestational diabetes mellitus pregnancies. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2016;37(2–3):99–105. doi: 10.1515/prilozi-2016-0022
  30. Nahavandi S, Seah JM, Shub A, et al. Biomarkers for macrosomia prediction in pregnancies affected by diabetes. Front Endocrinol (Lausanne). 2018;9:407. doi: 10.3389/fendo.2018.00407
  31. Zhou J, Zhao X, Wang Z, Hu Y. Combination of lipids and uric acid in mid-second trimester can be used to predict adverse pregnancy outcomes. J Matern Fetal Neonatal Med. 2012;25(12):2633–2638. doi: 10.3109/14767058.2012.704447
  32. Smith CJ, Baer RJ, Oltman SP, et al. Maternal dyslipidemia and risk for preterm birth. PLoS One. 2018;13(12):e0209579. doi: 10.1371/journal.pone.0209579

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版权所有 © Kapustin R., Tcybuk E., Alekseenkova E., Kopteeva E., Arzhanova O., Oparina T., Tumasova Z., 2021



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