Adverse Birth Outcome Among Mothers With Low Serum Cholesterol

Edison, Robin J.; Berg, Kate; Remaley, Alan T.; Kelley, Richard I.; Rotimi, Charles N.; Stevenson, Roger E.; Muenke, Maximilian

doi:10.1542/peds.2006-1939

Cited by 168 publications

(114 citation statements)

References 78 publications

(86 reference statements)

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“…One concern regarding the potential use of very low-fat diets in women without hyperlipidemic syndromes is whether there would be any adverse effect on fetal brain development. A previous observational study has reported the association of very low (,10th centile) maternal total cholesterol with increased rates of microcephaly (25).…”

Section: Diet and Exercisementioning

confidence: 95%

“…Low maternal HDL-C in early pregnancy has also been associated with increased risk of later GDM (23), and elevated HDL-C has been associated with lower rates of preterm birth (24). Both low (,10th centile) and high (.90th centile) maternal total cholesterol have been associated with preterm birth (6,25), with one study showing a trend to increased rates of microcephaly for low (,10th centile) maternal cholesterol (25) ( Table 2). Overall, there is good evidence that elevated triglycerides and low levels of HDL-C are associated with adverse maternal and neonatal outcomes for women without diabetes.…”

Section: Maternal Obesitymentioning

confidence: 99%

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Normalizing Metabolism in Diabetic Pregnancy: Is It Time to Target Lipids?

et al. 2014

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Outcomes in pregnancies complicated by preexisting diabetes (type 1 and type 2) and gestational diabetes mellitus have improved, but there is still excess morbidity compared with normal pregnancy. Management strategies appropriately focus on maternal glycemia, which demonstrably improves pregnancy outcomes for mother and infant. However, we may be reaching the boundaries of obtainable glycemic control for many women. It has been acknowledged that maternal lipids are important in pregnancies complicated by diabetes. Elevated maternal lipids are associated with preeclampsia, preterm delivery, and large-forgestational-age infants. Despite this understanding, assessment of management strategies targeting maternal lipids has been neglected to date. Consideration needs to be given to whether normalizing maternal lipids would further improve pregnancy outcomes. This review examines the dyslipidemia associated with pregnancy complicated by diabetes, reviews possible therapies, and considers whether it is time to start actively managing this aspect of maternal metabolism.Although rates of adverse outcomes in pregnancies complicated by preexisting diabetes (type 1 and type 2) and gestational diabetes mellitus (GDM) have improved, there is still excess maternal and fetal morbidity compared with normal pregnancy. Current management strategies focus on maternal glycemic control, which demonstrably improves pregnancy outcomes for mother and infant. Truly "normal" glucose levels in pregnancy appear lower than previously thought (1) and achieving currently recommended glucose targets in pregnancy carries a risk of hypoglycemia (2). The challenges in reaching glycemic targets before and after conception raise the question of whether other aspects of maternal metabolism could potentially be addressed to provide benefit to mother and infant.Multiple maternal metabolic, hormonal, and inflammatory factors other than maternal glucose are associated with maternal and fetal outcomes and are altered in pregnancies complicated by prepregnancy diabetes and GDM. These include maternal amino acids, glycerol, ketones, and lipids (3). Lipid management in diabetes is acknowledged as a key therapeutic target in the nonpregnant setting. However, it has not been accorded the same attention in pregnancy. Abnormal maternal lipids in pregnancy have been associated with preeclampsia (4,5), preterm delivery (6), and large-forgestational-age (LGA) infants (7). This review examines the dyslipidemia associated with pregnancy complicated by diabetes, reviews possible therapies, and considers whether there is sufficient evidence to start actively managing lipids in pregnancy. LIPID METABOLISM IN PREGNANCYMaternal metabolism is designed to provide adequate nutrition for fetal growth, in the form of glucose, ketones, lipids, and other fuels. In early pregnancy, maternal

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Section: Diet and Exercisementioning

confidence: 95%

Section: Maternal Obesitymentioning

confidence: 99%

Normalizing Metabolism in Diabetic Pregnancy: Is It Time to Target Lipids?

et al. 2014

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“…Recent association of low maternal serum cholesterol with preterm labor provides new support for this connection. 45 Nutrient-based treatments could be used in these targeted populations to prevent low birth weight or PTD, making further investigation of nutritional pathways key in the investigation of genetic predisposition to PTD.…”

Section: Future Studiesmentioning

confidence: 99%

Maternal and fetal variation in genes of cholesterol metabolism is associated with preterm delivery

et al. 2007

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Objective: To examine the contribution of variants in fetal and maternal cholesterol metabolism genes in preterm delivery (PTD).Study Design: A total of 40 single-nucleotide polymorphisms (SNPs) in 16 genes related to cholesterol metabolism were examined for 414 preterm infants (gestational ages 22 to 36 weeks; comprising 305 singletons and 109 twins) and at least 1 parent. Fetal effects were assessed using the transmission disequilibrium test (TDT) for each SNP, followed by a log linear model-based approach to utilize families with missing parental genotypes for those SNPs showing significance under TDT. Genetic variant effects were examined for a role in PTD, gestational age and birth weight. Maternal effects were estimated using a log linear model-based approach.Result: Among singleton gestations, suggestive association (P<0.01 without adjusting for multiple comparisons) was found between birth weight and fetal DHCR7 gene/SNP combinations (rs1630498, P ¼ 0.002 and rs2002064, P ¼ 0.003). Among all gestations, suggestive associations were found between PTD and fetal HMGCR (rs2303152, P ¼ 0.002) and APOA1 (rs 5070, P ¼ 0.004). The result for HMGCR was further supported by the log linear model-based test in the single births (P ¼ 0.007) and in all births (P ¼ 0.006). New associations (APOE and ABCA1) were observed when birth weight was normalized for gestational age suggesting independent effects of variants on birth weight separate from effects on PTD. Testing for maternally mediated genetic effects has identified suggestive association between ABCA1 (rs4149313, P ¼ 0.004) and decreased gestational age.Conclusion: Variants in maternal and fetal genes for cholesterol metabolism were associated with PTD and decreased birth weight or gestational age in this study. Genetic markers may serve as one mechanism to identify high-risk mothers and fetuses for targeted nutritional treatment and/or prevention of low birth weight or PTD.

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“…It is thought that progressive increase in oestrogen levels during gestation induces most of these alterations in lipoprotein metabolism (Desoye et al, 1987), which suggests the necessity of these metabolic changes for pregnancy maintenance and foetal growth. Indeed, reduced maternal TC levels are associated with intrauterine growth restriction and preterm delivery (Sattar et al, 1999;Edison et al, 2007). Conversely, marked elevated maternal TC and TG levels are associated with an increased risk on pre-eclampsia and other pregnancy-related complications (vandenElzen et al, 1996;Enquobahrie et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Ethnic differences in maternal total cholesterol and triglyceride levels during pregnancy: the contribution of demographics, behavioural factors and clinical characteristics

et al. 2011

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Background/Objectives: Lipid disturbances during pregnancy may lead to early onset of metabolic diseases in the offspring. However, there is little knowledge on ethnic differences in lipid levels during pregnancy. We evaluated ethnic differences in non-fasting total cholesterol (TC) and triglyceride (TG) levels during early gestation and the role of demographics, behavioural factors and clinical characteristics. Subjects/Methods: Non-diabetic pregnant women (N ¼ 3025) from the Amsterdam Born Children and their Development (ABCD) study. The studied ethnic groups were Dutch, Surinam-Hindustani, African-Caribbean, Turkish, Moroccan and Ghanaian. A multilingual questionnaire was used to gather information on maternal demographics, behavioural factors and clinical characteristics. Non-fasting TC, TG, percentage saturated fatty acid (%SFA) and percentage linoleic acid status (%LA) were assessed in blood samples collected at the first antenatal visit. Results: Ghanaian (À0.51 mmol/l), African-Caribbean (À0.19 mmol/l) and Moroccan (À0.15 mmol/l) women had significant lower TC levels compared with Dutch women. TG levels were lower in Ghanaian (log transformed À0.12 mmol/l) but significantly higher in Surinam-Hindustani (0.10 mmol/l) and Turkish women (0.07 mmol/l). Age, physical activity, pre-pregnancy body mass index (BMI), smoking, %SFA and %LA were independently related to TC and/or TG. However, only pre-pregnancy BMI could partly explain observed disparities. Furthermore, pre-pregnancy BMI had a relatively large effect on TG levels in Surinam-Hindustani and Turkish women. Conclusions: TC and TG levels differed between ethnic groups during early gestation. Only pre-pregnancy BMI partly explained the ethnic differences to a relevant degree. Reduction in BMI before pregnancy may improve lipid profile, especially in Surinam-Hindustani and Turkish women.

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Adverse Birth Outcome Among Mothers With Low Serum Cholesterol

Abstract: Total serum cholesterol <10th population percentile was strongly associated with preterm delivery among otherwise low-risk white mothers in this pilot study population. Term infants of mothers with low total cholesterol weighed less than control infants among both racial groups.

Cited by 168 publications

References 78 publications

Normalizing Metabolism in Diabetic Pregnancy: Is It Time to Target Lipids?

Normalizing Metabolism in Diabetic Pregnancy: Is It Time to Target Lipids?

Maternal and fetal variation in genes of cholesterol metabolism is associated with preterm delivery

Ethnic differences in maternal total cholesterol and triglyceride levels during pregnancy: the contribution of demographics, behavioural factors and clinical characteristics

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