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Plasma concentrations of lipids during pregnancy and the risk of gestational diabetes mellitus: A longitudinal study.

ABSTRACT: BACKGROUND:Abnormal lipid profiles have been associated with gestational diabetes mellitus (GDM), but studies with longitudinal measures of lipids throughout pregnancy are sparse. The aim of the present study was to characterize longitudinal changes in lipid profiles throughout pregnancy and prospectively examine the associations of plasma lipid concentrations with risk of GDM. METHODS:This study was a nested case-control study including 107 GDM cases and 214 matched non-GDM controls from participants in the National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies - Singleton cohort. Blood samples were collected longitudinally at Gestational Weeks (GW) 10-14, 15-26 (fasting sample), 23-31, and 33-39. Plasma concentrations of triglycerides, total cholesterol, and high-density lipoprotein cholesterol (HDL-C) were measured by enzymatic assays. Low-density lipoprotein cholesterol (LDL-C) was calculated using Friedewald's formula. RESULTS:Plasma triglycerides, total cholesterol, and LDL-C increased as pregnancy progressed. At GW 10-14, the adjusted odds ratios (aORs) of GDM comparing the highest versus lowest quartile were 3.15 (95% confidence interval [CI] 1.38-7.15; P trend ?=?0.002) for triglycerides and 0.44 (95% CI 0.18-1.09; P trend ?=?0.045) for HDL-C. At GW 15-26, the aORs were 6.57 (95% CI 2.25-19.17; P trend ?=?0.001) for triglycerides and 0.23 (95% CI 0.08-0.63; P trend ?=?0.005) for HDL-C. No significant associations were observed for total cholesterol and LDL-C concentrations with risk of GDM. CONCLUSIONS:Higher plasma triglyceride and lower HDL-C concentrations in early and mid-pregnancy were significantly associated with a greater risk of GDM. Total cholesterol and LDL-C concentrations during pregnancy were not significantly associated with GDM risk.

SUBMITTER: Bao W

PROVIDER: S-EPMC5837900 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Plasma concentrations of lipids during pregnancy and the risk of gestational diabetes mellitus: A longitudinal study.

Bao Wei W Dar Sharon S Zhu Yeyi Y Wu Jing J Rawal Shristi S Li Shanshan S Weir Natalie L NL Tsai Michael Y MY Zhang Cuilin C

Journal of diabetes 20170929 6

<h4>Background</h4>Abnormal lipid profiles have been associated with gestational diabetes mellitus (GDM), but studies with longitudinal measures of lipids throughout pregnancy are sparse. The aim of the present study was to characterize longitudinal changes in lipid profiles throughout pregnancy and prospectively examine the associations of plasma lipid concentrations with risk of GDM.<h4>Methods</h4>This study was a nested case-control study including 107 GDM cases and 214 matched non-GDM contr ...[more]

PMID: 28436169

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Project description:Maternal dietary patterns before and during pregnancy play important roles in the development of gestational diabetes mellitus (GDM). We aimed to identify dietary patterns during pregnancy that are associated with GDM risk in pregnant U.S. women. From a 24 h dietary recall of 253 pregnant women (16-41 years) included in the National Health and Nutrition Examination Survey (NHANES) 2003-2012, food items were aggregated into 28 food groups based on Food Patterns Equivalents Database. Three dietary patterns were identified by reduced rank regression with responses including prepregnancy body mass index (BMI), dietary fiber, and ratio of poly- and monounsaturated fatty acids to saturated fatty acid: "high refined grains, fats, oils and fruit juice", "high nuts, seeds, fat and soybean; low milk and cheese", and "high added sugar and organ meats; low fruits, vegetables and seafood". GDM was diagnosed using fasting plasma glucose levels ?5.1 mmol/L for gestation <24 weeks. Multivariable logistic regression models were used to estimate adjusted odds ratio (AOR) and 95% confidence intervals (CIs) for GDM, after controlling for maternal age, race/ethnicity, education, family poverty income ratio, marital status, prepregnancy BMI, gestational weight gain, energy intake, physical activity, and log-transformed C-reactive protein (CRP). All statistical analyses accounted for the appropriate survey design and sample weights of the NHANES. Of 249 pregnant women, 34 pregnant women (14%) had GDM. Multivariable AOR (95% CIs) of GDM for comparisons between the highest vs. lowest tertiles were 4.9 (1.4-17.0) for "high refined grains, fats, oils and fruit juice" pattern, 7.5 (1.8-32.3) for "high nuts, seeds, fat and soybean; low milk and cheese" pattern, and 22.3 (3.9-127.4) for "high added sugar and organ meats; low fruits, vegetables and seafood" pattern after controlling for maternal sociodemographic variables, prepregnancy BMI, gestational weight gain, energy intake and log-transformed CRP. These findings suggest that dietary patterns during pregnancy are associated with risk of GDM after controlling for potential confounders. The observed connection between a high consumption of refined grains, fat, added sugars and low intake of fruits and vegetables during pregnancy with higher odds for GDM, are consistent with general health benefits of healthy diets, but warrants further research to understand underlying pathophysiology of GDM associated with dietary behaviors during pregnancy.

Project description:ObjectiveTo investigate the correlation of trends in lipid profiles from first to second trimester with trends in insulin indices and gestational diabetes mellitus (GDM).MethodsSecondary analysis of an ongoing prospective cohort study was conducted on 1234 pregnant women in a single center. Lipid profiles, glucose metabolism and insulin indices were collected in the first and second trimesters. Trends in lipid profiles were divided into four subgroups: low-to-low, high-to-high, high-to-low and low-to-high group. Insulin indices including homeostasis model assessment of insulin resistance and quantitative insulin sensitivity check index were calculated to evaluate insulin resistance (IR). Trends in insulin indices were described as: no IR, persistent IR, first-trimester IR alone and second-trimester IR alone. Pearson correlation analysis and multivariate logistic regression were performed to assess the associations of lipid profiles subgroups with insulin indices and GDM.ResultsFirst- and second-trimester total cholesterol (TC), triglycerides (TG) and high-density lipoprotein cholesterol were strongly correlated to first- and second-trimester insulin indices. Only TG had a sustained correlation with glucose metabolism indices. High-to-high low-density lipoprotein cholesterol (LDL-c) was an independent risk factor for GDM. High-to-high TG and high-to-low TG groups were independent risk factors for persistent IR. High-to-high TG and low-to-high TG groups were independent risk factors for second-trimester IR alone.ConclusionTG has a sustained correlation with insulin indices and glucose metabolism indices. Persistently high TG is an independent risk factor for persistent IR and second-trimester IR alone. Regardless of whether pregnant women have first-trimester IR, lower TG levels help reduce the risk for persistent IR or subsequent development of IR. These results highlight the benefit of lowering TG levels in early and middle pregnancy to prevent the development of IR.

Project description:Aims/hypothesisDespite recommendations to screen women with diabetes risk factors for hyperglycaemia in the first trimester, criteria for normal glucose values in early pregnancy have not been firmly established. We aimed to compare glucose levels in early pregnancy with those later in gestation and outside of pregnancy in women with diabetes risk factors.MethodsIn pregnant women (N = 123) followed longitudinally through the postpartum period, and a separate cohort of non-pregnant women (N = 65), we performed 75 g oral glucose tolerance tests. All participants had one or more risk factors for diabetes. Using linear regression, we tested for differences in glucose levels between non-pregnant and pregnant women at early (7-15 weeks) and mid-late (24-32 weeks) gestation as well as postpartum, with adjustment for maternal age, parity, marital status and BMI. In a longitudinal analysis using mixed-effects models, we tested for differences in glucose levels across early and mid-late pregnancy compared with postpartum. Differences are expressed as β (95% CI).ResultsFasting glucose was lower in pregnant compared with non-pregnant women by 0.34 (0.18, 0.51) mmol/l (p < 0.0001) in early pregnancy and by 0.45 (0.29, 0.61) mmol/l (p < 0.0001) in mid-late pregnancy. In longitudinal models, fasting glucose was lower by 0.13 (0.04, 0.21) mmol/l (p = 0.003) in early pregnancy and by 0.16 (0.08, 0.25) mmol/l (p = 0.0003) in mid-late pregnancy compared with the same women postpartum. Early pregnancy post-load glucose levels did not differ from those in non-pregnant women or the same women postpartum. In mid-late pregnancy, compared with non-pregnant women, elevations in 1 h post-load glucose level (0.60 [-0.12, 1.33] mmol/l, p = 0.10) and 2 h post-load glucose (0.49 [-0.21, 1.19] mmol/l, p = 0.17) were not statistically significant. However, in longitudinal analyses, 1 h and 2 h post-load glucose levels were higher in mid-late pregnancy (by 0.78 [0.35, 1.21] mmol/l, p = 0.0004, and 0.67 [0.30, 1.04] mmol/l, p = 0.0005, respectively) when compared with postpartum.Conclusions/interpretationIn women with diabetes risk factors, fasting glucose declines in the first trimester. Post-load glucose increases later in pregnancy. These findings may inform criteria for diagnosing hyperglycaemia early in pregnancy.

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Plasma concentrations of lipids during pregnancy and the risk of gestational diabetes mellitus: A longitudinal study.

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Plasma concentrations of lipids during pregnancy and the risk of gestational diabetes mellitus: A longitudinal study.

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