Establishment of trimester-specific reference intervals of serum lipids and the associations with pregnancy complications and adverse perinatal outcomes: a population-based prospective study

Abstract

Background Disturbances in maternal lipid metabolism may increase the risk of developing pregnancy complications and adverse perinatal outcomes. However, there is no consensus as to what constitutes normal serum lipid ranges during pregnancy. Our study was aimed to establish trimester-specific serum lipid reference intervals (RIs) and investigate the associations between maternal dyslipidaemia and adverse outcomes in a population-based study. Methods The first- and third-trimester lipid profiles were derived from 16,489 singlet pregnant women for regular antenatal check-ups between 2017 and 2019. The serum samples were assayed for total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol (LDL-C) in the institutional clinical laboratory. The trimester-specific lipid RIs were estimated with both of the direct observational and the indirect Hoffmann methods. The associations between maternal lipid profiling and pregnancy complications and perinatal outcomes were assessed statistically. Results Serum levels of TC, TG, LDL-C and HDL-C were all increased significantly in the third trimester of pregnancy. There was no significant difference between the observed RIs established with healthy pregnant women and the calculated RIs derived from the Hoffmann method. A trend towards increased risks of gestational complications and adverse perinatal outcomes was observed in the subjects with elevated levels of TC, TG, and LDL-C or decreased level of HDL-C. Conclusions In pregnancy, increased serum levels of TC, TG and LDL-C, and a decreased level of HDL-C posed higher risks of developing pregnancy complications and adverse perinatal outcomes. Key messages It is necessary to establish trimester-specific reference intervals for serum lipids including TC, TG, LDL-C and HDL-C that were found significantly increased as the gestational age went up. More importantly, around the upper reference limits of TC, TG and LDL-C (or the lower reference limit of HDL-C), the higher the serum lipid levels were (or the lower the HDL-C level was), the higher risks of developing pregnancy complications and adverse perinatal outcomes were observed.

Association between second and third trimester maternal lipid profiles and adverse perinatal outcomes among women with gestational diabetes mellitus: A retrospective cohort study

“…Our results showed that maternal serum TC, LDL, TG, and HDL levels increased as the pregnancy advanced. Furthermore, in this study, the women with GDM had signi cantly higher TC and TG levels in the second and third trimesters compared with non GDM, whereas HDL levels decreased in women with GDM, consistent with previous reports [21,23]. However, previous studies have indicated no signi cant difference in serum TC, HDL, and LDL levels between women with and without GDM [25,26,34].…”

“…Maternal lipid metabolism changes during pregnancy are common, physiologically necessary to ensure fetal growth, [18,19] and include moderate increases in lipids in the rst trimester and signi cant increases in lipids in the second and third trimesters, especially in triglyceride (TG) and cholesterol levels [20,21]. However, dyslipidemia may lead to pregnancy complications and adverse perinatal outcomes [16].…”

Significance of levothyroxine treatment on serum lipid in pregnant women with subclinical hypothyroidism

“…found that TG level in the first trimester of pregnancy could increase the of risk of large-for-gestational age (LGA). Similar to their results, Lu et al [ 26 ] demonstrated that TG level in the first trimester of pregnancy had a strong positive association with GDM. Therefore, with the establishment of reference ranges for serum lipids during pregnancy, the level of serum lipids can be used as predictive and warning factors for some adverse pregnancy outcomes.…”

Dissecting the Roles of Lipids in Preeclampsia

“…Alteration in lipid concentration has been reported to be a risk factor for preeclampsia [ 17 ]. In addition, the accumulation of lipids and lipoproteins in the arterial wall could induce the formation of atheroma plaques and thus promote subsequent atherosclerosis [ 18 , 19 ].…”