Association between maternal triglycerides and disturbed glucose metabolism in pregnancy

Abstract

Aims Dyslipidemia in pregnancy is associated with adverse pregnancy outcomes as elevated triglycerides might be considered as a risk factor for hyperglycemia and gestational diabetes. As only a few studies have addressed the association between maternal triglycerides and glucose metabolism, we aimed to explore the pathophysiologic associations of moderate hypertriglyceridemia and maternal glucose metabolism in pregnancy. Methods Sixty-seven pregnant women received a detailed metabolic characterization at 12+0–22+6 weeks of gestation by an extended 2h-75g OGTT (oral glucose tolerance test); with measurements of glucose, insulin and C-peptide at fasting and every 30 min after ingestion and assessment of triglycerides at fasting state. All examinations were repeated at 24+0–27+6 weeks of gestation. Results Elevated triglycerides in early gestation were associated with insulin resistance and β-cell dysfunction. Mean glucose concentrations during the OGTT in early pregnancy were already higher in women with hypertriglyceridemia as compared to women with triglycerides in the normal range. A higher degree of insulin resistance and increased OGTT glucose levels were also observed when metabolic assessments were repeated between 24 and 28 weeks of gestation. Of note, elevated triglycerides at early gestation were associated with development of gestational diabetes by logistic regression (odds ratio: 1.16, 95%CI: 1.03–1.34, p=0.022 for an increase of 10 mg/dl). Conclusions Hypertriglyceridemia at the start of pregnancy is closely related to impaired insulin action and β-cell function. Women with hypertriglyceridemia have higher mean glucose levels in early- and mid-gestation. Pregnant women with elevated triglycerides in early pregnancy are at increased risk of developing gestational diabetes.

Screening of postpartum diabetes in women with gestational diabetes: high-risk subgroups and areas for improvements—the STRONG observational study

“…Established risk factors for GDM include ethnicity, obesity, and family history of diabetes [26,27], while lower insulin sensitivity, use of insulin therapy, pre-pregnancy obesity, severity of GDM and high HbA1c levels during pregnancy were identified as independent predictors of subsequent diabetes in previous observational studies [28][29][30], in line with our data. Our study adds novel information about their interaction and their priority in identifying specific phenotypes.…”

The interactive effects of pre-pregnancy body mass index, thyroid function, and blood lipid levels on the risk of gestational diabetes mellitus: a crossover analysis

“…The result indicated that 34.8% of the GDM risk could be attributed to the presence of interaction between thyroid hormone and TG levels in pregnant women. Dyslipidemia during pregnancy, especially hypertriglyceridemia, was closely associated with a greater risk of GDM [21,45], and the possible mechanisms including impaired insulin action, β-cell function, and nitric oxide signaling [21,46]. As shown by a previous study, FT3/FT4 ratio was positively associated with multiple risk factors for GDM, including homeostasis model assessment of insulin resistance (HOMA-IR), waist circumference, triglyceride levels, fasting blood glucose, and systolic blood pressure [47].…”

“…Several cross-sectional studies have shown that the free triiodothyronine (FT3)/free thyroxine (FT4) ratio, a commonly used indicator for thyroid function, is associated with higher insulin resistance, glycated hemoglobin, fasting glucose, post-load glucose levels, and increased risk of GDM in pregnancy women [19,20 ]. Dyslipidemia was also associated with insulin resistance and β-cell dysfunction in pregnant women [21] and was found to be an independent predictor for GDM [22]. Moreover, there was evidence that thyroid dysfunction may also be a risk factor for dyslipidemia [23,24].…”

Maternal AA/EPA Ratio and Triglycerides as Potential Biomarkers of Patients at Major Risk for Pharmacological Therapy in Gestational Diabetes

“…Hypertriglyceridemia has been related to impaired insulin action and β-cell function in pregnancy. This molecular mechanism has been associated with a higher risk of developing GD, even in the case of moderately elevated levels [41][42][43]. However, to our knowledge, there is insufficient evidence on the effects of standard treatment for diabetes on hypertriglyceridemia [44].…”