Feto-maternal impact of altered lipid profile in pregnancy

Abstract

INTRODUCTIONHypertensive disorders complicate approximately 10% of all pregnancies worldwide, with onset of symptoms in the late second or third trimester, most commonly after the 32nd week.1 The national incidence is reported to be 8-10%.2 Preeclampsia is one of the major cause of maternal mortality in developed and developing countries. It is also a leading cause of perinatal morbidity and mortality and it is very strongly related to fetal growth retardation. To avoid complications, it is very important to diagnose it early, but the available tools are unable to clinch the diagnosis of preeclampsia effective in majority. Pregnancy-induced hypertension(PIH) is one of the major risk factors in present day health care practice because it not only causes maternal mortality but also impaires fetal development during pregnancy. Pre-eclampsia is a multi-system disorder of pregnancy, which is characterised by new onset hypertension and proteinuria that develop after 20 weeks of gestation in previously normotensive women. Pregnancy-induced hypertension(PIH) is one of the major risk factors in present day health care practice because it not only causes Results:Out of 200 antenatal women recruited in our study, 129 had normal lipid profile throughout pregnancy and 71 women developed dyslipidemia.89 % of those women having normal lipid profile did not develop any maternal or perinatal complication, showing a high negative predictive value (88.72%) and high specificity of 91.47%. We observed that the onset of dyslipidemia occurred in 2nd trimester and it was progressive. About 83.58 % of them developed toxemia of pregnancy (GHTN, preeclampsia, eclampsia), positive predictive value of 83.58%. The levels of TC (total cholesterol), TG(triglyceride), VLDL (very low-density lipoprotein) and LDL (low density lipoprotein) were significantly (p<0.0001) higher in hypertensive women than normotensive women. Dyslipidemic women have developed significant (p= 0.00001) level of perinatal complications like preterm (18.05%), IUGR (15.28%) and IUD (13.89%). Sensitivity-78.9, Specificity-88.72, Positive likelihood ratio-9.25, Negative likelihood ratio-0.23. Conclusions: Early pregnancy dyslipidemia was significantly associated with an increased risk of preeclampsia and eclampsia. Thus, evaluating dyslipidemia in 1 st and 2 nd trimester may help in early prediction and management of maternal as well as fetal complication.

Role of lipid profile in early second trimester for prediction of pre-eclampsia

“…Singh et al in their study found that the women with preeclampsia with poor fetal outcome had to be induced resulting in preterm deliveries, similar results were seen in our study. 19 Post-partum eclampsia was higher in preeclampsia group (17.24% vs 0%; p value<0.0001) than in normotensive group. No mortality was seen from preeclampsia in the study.…”

Ethnic Disparities and Obesity Risk Factors in Pregnant Women: A Retrospective Observational Cohort Study

“…[ 34 ]. Singh et al [ 35 ] reported a strong association between dyslipidemia and pregnancy-induced hypertension, as well as intrauterine growth restriction, intrahepatic cholestasis, macrosomia, and fetal death [ 36 ]. Thus, the determination of the lipid profile is greatly recommended to introduce rapid management approaches to prevent the damaging effect of dyslipidemia associated with pregnancy [ 37 ].…”

Maternal Lipid Profile and Its Impact on Pregnancy Outcome

“…There is accumulation of TG-rich remnants in maternal circulation due to reduced lipolysis of TG-rich lipoproteins, reduced uptake by the placental tissue, and concomitant decrease in lipoprotein lipolysis. 1 During pregnancy there is an increased levels of both TG and TC, which are essential for the development of fetus; [2][3][4][5] however, high levels are associated with adverse outcomes like gestational diabetes mellitus, preterm labor, 6 pregnancy-induced hypertension (PIH), 7,8 large for gestational age babies. [9][10][11] Conversely decreased level of total cholesterol is associated with SGA babies.…”