Gestational Hyperlipidemia and Perinatal Outcomes

Abstract

The incidence of diabetes mellitus among pregnant women is increasing. Physiological hyperlipidemia, characteristic of the late period of pregnancy, is aggravated during pregnancy complicated by diabetes mellitus. Changes in the lipid profile are inextricably linked to adverse perinatal outcomes. However, there are not enough studies aimed at studying the relationship between lipid metabolism and the development of obstetric complications in women with different types of diabetes. The aim of this study is to assess the lipid profile in women with different types of diabetes mellitus (type 1, 2 and gestational diabetes), taking into account the method of its correction in the third trimester of pregnancy, to determine the relationship between lipids and perinatal complications and to determine their possible prognostic significance in the development of adverse pregnancy outcomes.

Materials and methods. The study included 277 women, who formed several comparison groups depending on the type of diabetes mellitus and the method of its correction, a group of women with preeclampsia and a group of conditionally healthy women. We analyzed clinical and laboratory data from outpatient and inpatient records of pregnant women registered under dispensary control from 2010 to 2017. For the study, we used peripheral venous blood taken on an empty stomach from pregnant women at 28-32 weeks of gestation. The main outcome of the study was the level of triglycerides, cholesterol, high, low and very low density lipoproteins, and the atherogenic index. In addition, the incidence of gestational hypertension, preeclampsia, fetal growth retardation, and preterm birth was assessed.

Results of the study. Pregnant women with various types of diabetes mellitus are characterized by a predominance of atherogenic lipids (triglycerides, very low density lipoproteins) in the blood serum, an increase in the atherogenic index and a decrease in the content of antiatherogenic high density lipoproteins. These changes are most pronounced in pregnant women with pregestational types of diabetes and in groups of patients receiving insulin therapy. When conducting a correlation analysis, a weak direct relationship was found between the level of triglycerides and macrosomia ( r = 0.26) and the value of the atherogenic index and the development of severe preeclampsia ( r = 0.26). Analysis of the ROC curve showed that triglycerides, very low density lipoproteins and the atherogenic index are predictors of the development of severe preeclampsia.

Conclusion : Diabetes mellitus increases the incidence of dyslipidemia in pregnant women, which plays an important role in the pathogenesis of many perinatal complications. Assessment of lipid profile markers in women with various types of diabetes mellitus during the third trimester of pregnancy may be an accurate method for predicting severe preeclampsia.