Early postpartum dyslipidemia and its potential predictors during pregnancy in women with a history of gestational diabetes mellitus

Abstract

Background This study aimed to analyze the incidence of early postpartum dyslipidemia and its potential predictors in women with a history of gestational diabetes mellitus (GDM). Methods This was a retrospective study. Five hundred eighty-nine women diagnosed with GDM were enrolled and followed up at 6–12 weeks after delivery. A 75 g oral glucose tolerance test (OGTT) and lipid levels were performed during mid-trimester and the early postpartum period. Participants were divided into the normal lipid group and dyslipidemia group according to postpartum lipid levels. Demographic and metabolic parameters were analyzed. Multiple logistic regression was performed to analyze the potential predictors for early postpartum dyslipidemia. A receiver operating characteristic curve (ROC) was calculated to determine the cut-off values. Results A total of 38.5% of the 589 women developed dyslipidemia in early postpartum and 60% of them had normal glucose metabolism. Delivery age, systolic blood pressure (SBP), glycated hemoglobin (HbA1c) and low-density lipoprotein cholesterol (LDL-C) were independent predictors of early postpartum dyslipidemia in women with a history of GDM. The cut-offs of maternal age, SBP, HbA1c values, and LDL-C levels were 35 years, 123 mmHg, 5.1%, and 3.56 mmol/L, respectively. LDL-C achieved a balanced mix of high sensitivity (63.9%) and specificity (69.2%), with the highest area under the receiver operating characteristic curve (AUC) (0.696). When LDL-C was combined with age, SBP, and HbA1c, the AUC reached to 0.733. Conclusions A lipid metabolism evaluation should be recommended in women with a history of GDM after delivery, particularly those with a maternal age > 35 years, SBP > 123 mmHg before labor, HbA1c value > 5.1%, or LDL-C levels > 3.56 mmol/L in the second trimester of pregnancy.

Development of ALOHa-G Risk Score for Detecting Postpartum Dyslipidemia Among Normoglycemic Women with Previous Gestational Diabetes: Observational Cohort Study

“…The HbA1c cutoff for a high risk profile for postpartum dyslipidemia in normoglycemic women with pGD in our study was almost in agreement with previous findings [4]. According to our results, even in conditions where glycemic goals (FPG and HbA1c) are achieved, women with GD might be at risk for postpartum dyslipidemia after delivery, even when they are normoglycemic [4]. On the other hand, lipid parameters during mid-pregnancy should not be ignored due to a lack of therapeutic importance.…”

“…Simultaneously, it has been shown that age, weight, and lipid status during pregnancy are associated with the risk of postpartum dyslipidemia [4][5][6]. On the other hand, dyslipidemia during pregnancy is a common physiological phenomenon, especially after mid-trimester, since increased levels of lipids are essential for fetus development [7].…”

Gestational Diabetes Mellitus Among Asians – A Systematic Review From a Population Health Perspective

“…Existing data on risk factors of T2D among women with a history of GDM were firstly reported in the NHW population, such as greater pre-pregnancy BMI ( 8 , 9 ), excessive weight gain ( 3 ), unhealthy dietary patterns ( 3 ), physical inactivity ( 3 ), and a short period of lactation ( 3 , 10 ). In the Asian population, there are also quite a few at-risk pre-natal maternal characteristics recently added to this pond of evidence, such as family history of diabetes ( 43 ), a higher degree of consanguineous marraiges ( 43 ), higher pre-pregnancy BMI ( 29 , 31 , 32 , 46 ), higher total cholesterol quartile at GDM diagnosis during the index pregnancy ( 47 ), younger age at delivery (<30 years) ( 46 ), and a short period of lactation (<6 months) ( 33 ). Post-natal risk such as missing medical assistance in the continuum of GDM care after delivery could be another risk for T2D progression among Asian mothers with a history of GDM ( 48 ).…”

“…In Asia, five studies reported metabolic syndrome in Asian women with a history of GDM, with an incidence rate ranging from 40 to 90 per 1000 person-years. One Chinese study reported postpartum dyslipidemia (38.5%) among women with a history of GDM ( 47 ), while the other Israelite study reported a 30-70% higher risk of developing CV events and CV hospitalization among women with a history of GDM, even after adjusting for pre-eclampsia and maternal obesity at index pregnance ( 39 ).…”

The Edmonton Obesity Staging System and pregnancy outcomes in women with overweight or obesity: A secondary analysis of a randomized controlled trial

“…In women with a history of GDM, LDL cholesterol levels >3.56 mmol/L in the second trimester were associated with increased risk of dyslipidaemia at 6–12 weeks post‐delivery. 41 Darmady and Postle found cholesterol levels remained elevated up to 36 weeks post‐partum. 39 The degree of change experienced may also influence associations with outcomes.…”