Lipid Metabolism in Pregnancy: V. Interactions of Diabetes, Body Weight, Age, and High Carbohydrate Diet

Abstract

Plasma triglycerides increase two-to-three-fold in normal pregnancy. If mechanistically similar to the atherosclerosis-associated hypertriglyceridemias, hypertriglyceridemia in pregnancy should be exaggerated by diabetes, obesity, and high carbohydrate feeding. A failure to exaggerate would point to a different physiologic mechanism. To study this matter, we measured fasting plasma triglyceride and cholesterol In 38 normal, 22 gestational-diabetic, and 27 overtly diabetic women in the third trimester, measuring the concomitant effects of age and body weight and, in four subjects, high carbohydrate feeding.Compared with controls, fasting plasma triglyceride and cholesterol were unchanged hi gestational diabetics and hi 10 of the 27 overtly diabetic pregnant women treated with insulin and diet. However, 17 of 27 diabetic women treated with an estrogenprogestin supplement during gestation had a 36 per cent higher triglyceride and a 15 per cent higher cholesterol than control. Body weight, age, duration of diabetes, or length of gestation could not account for the observations. In non-hormone-treated subjects, regression analysis showed a positive correlation of triglycerides with age but not with body weight. High carbohydrate feeding in pregnancy produced a triglyceride increase (mean±S.D.) of 9±19 per cent in whole plasma and 17 ±13 per cent in very-low-density Upoprotein. Respective postpartum increases were 41 and 68 per cent, similar to the responses reported in nonpregnant Individuals.Conclusion: Lack of a major effect of diabetes, body weight, and high carbohydrate feeding on blood lipids hi gestation distinguishes pregnancy from the atherosclerosis-associated hypertriglyceridemias and points to a different physiologic control mechanism. DIABETES 26:1056-62, November, 1977.The endogenous hypertriglyceridemia of pregnancy is a physiologic event 1 2 distinguished from From the 1056 atherosclerosis-associated hypertriglyceridemias 3 by an increased h i g h -d e n s i t y -l i p o p r o t e i n (HDL)* cholesterol. 4 ' 6 This change resembles that seen in oral contraceptive steroid therapy, suggesting that the hypertriglyceridemia of pregnancy is hormonally cont r o l l e d . 2 4 7 8In this paper we attempt to characterize the hypertriglyceridemia of pregnancy by its response to diabetes, body weight, and high carbohydrate feeding, factors known to aggravate the atherosclerosisassociated hypertriglyceridemias. 9 " 11 An exaggerated response in pregnancy would suggest a mechanistic similarity to hypertriglyceridemias in general. A failure to exaggerate would point to a different physiologic control mechanism, presumably related to the sex hormones of pregnancy. The results support the latter possibility. Some of the results have been presented in abstract form. 12 METHODS Fasting Lipid Measurements; Subjects and ProceduresThree-hour oral glucose tolerance tests (OGTT) were performed in 64 pregnant women who were referred to the Diabetes Clinic of the Boston City Hospital. One hundred grams of glucose was given a...

Lipoprotein Metabolism in Pregnancy, Fat Transport to the Fetus, and the Effects of Diabetes

“…While an increase in fetal body weight would be expected if the increased transpla cental transfer of glucose and fatty acids to the fetus were being assimilated by the fetus, fetal macrosomia in this model is not consis tently seen [45]. Nonetheless, these data sup port the hypothesis that increased plasma triglyceride concentrations in diabetic preg nancy [30] (also see below) may enhance fatty acid transport across the placenta through the permissive, sustained activity of placental LPL. The sustained activity of LPL in the placenta of pregnant diabetic rat is consistent with an insensitivity of other as pects of placental metabolism to perturba tions in maternal fuel physiology [46].…”

“…As mentioned earlier, exaggerated hypertriglyc eridemia seems to be a feature of gestational [52][53][54] and overt type II diabetes in preg nancy [30,53,54] and HDL cholesterol tends to be reduced in those conditions [53,54], Examples of VLDL triglyceride and HDL cholesterol changes in type II diabetic pregnancy are presented in figure 12, show ing that levels can be abnormal in diabetic pregnancy and return to normal postpartum [53], Previous reports of type I diabetes in pregnancy [53,54], involving limited num bers of subjects, suggested that HDL choles-tcrol was increased in type I diabetes in preg nancy as it is in nonpregnant type I diabetic subjects [for review, see 55]. However, a re cent analysis by Van Allen et al [56] of a larger number of pregnant type 1 diabetics followed throughout gestation indicates that cholesterol in HDL and HDLi are both re duced throughout gestation.…”

“…We have performed such a study in 22 normal pregnant women at vaginal delivery comparing umbilical cord arteriovenous differences for total protein measured by the Lowry method, total plasma triglyceride and cholesterol mea sured by AutoAnalyzer I techniques, FFA measured by the Dole titration technique and glucose measured by an AutoAnalyzer Ferricyanide method as previously described [29,30], Simultaneous venous measure ments of the same fuels were obtained from the mother at the time of delivery of the umbilical cord and placenta.…”

A study of lipid parameters among GDM and non GDM pregnant women: a hospital based study

“…7 Women with GDM are at significantly increased risk of developing metabolic dysfunction after pregnancy including hyperlipidaemia. 8 Although many studies suggest that women with GDM have increased levels of triglycerides, LDL-C and total cholesterol and lower levels of HDL-C, these findings are generally inconsistent. 3 Alterations in maternal lipid metabolism are a normal part of pregnancy with an early accumulation of lipids in maternal tissue and the development of hyperlipidaemia in the latter half of pregnancy.…”

Offspring Birth Weight and Maternal Fasting Lipids in Women Screened for Gestational Diabetes Mellitus

“…In a normal pregnancy, the compensatory mechanism by the pancreas makes up for the reduced effectiveness of insulin by increasing secretion of the hormone 26 . Plasma insulin levels are generally insufficient to prevent a certain degree of hyperlipidemia in normal pregnancy 27 . Estrogen has also been proven to increase endogenous production of VLDL TG, decrease adipose tissue lipoprotein lipase activity and hinder hepatic TG lipase activity 28 .…”