Maternal hypertriglyceridemia: A link between maternal overweight-obesity and macrosomia in gestational diabetes

Abstract

Objective: Infants born from overweight and obese mothers with glucose-controlled gestational diabetes (GDM) tend to be large-for-gestational age (LGA). It is hypothesized that this is due to an excessive rise in maternal triglyceride levels. Methods: Two-hundred and seventy nine singleton GDM pregnancies were divided into three groups according to prepregnancy BMI: normal weight (BMI 5 20-24.9; n 5 128), overweight (BMI 5 25-29.9; n 5 105), and obese (BMI 30; n 5 46). Individual z-scores (ZS) of maternal triglycerides and of newborn weight (NWZS) were calculated as deviations from published 50th percentiles. Mean z-scores (MZS) were the average of triglyceride ZSs. MZS of triglycerides, HbA1c and NWZS were compared. Variables are expressed as mean 6 SD. Results: In the three groups respectively: LGA (%) 5 10.1%, 19.0% and 30.4% (P 5 0.015). Birth weight (g) 5 3274.2 6 501.3, 3342.4 6 620.2 and 3366.36644.7 (R SPEARMAN 5 0.111, P 5 0.027). HbA1c (%) 5 5.2 6 0.39, 5.3 6 0.50 and 5.4 6 0.47 (P 5 NS). Triglyceride MZS 5 1.20 6 1.13, 1.52 6 1.37 and 1.62 6 1.42 (R SPEARMAN 5 0.116, P 5 0.024). Correlations between triglyceride MZS and NWZS were, respectively: r 5 0.12 (P 5 NS), r 5 0.42 (P <0.001), and r 5 0.47 (P < 0.001). Conclusions: In overweight and obese GDM mothers, maternal triglycerides are partially responsible for LGA infants despite good maternal glucose control during pregnancy.

Cross-sectional and longitudinal lipid determination studies in pregnant women reveal an association between increased maternal LDL cholesterol concentrations and reduced human umbilical vein relaxation

“…Furthermore, we note the possibility that pathogenic effects in pregnant women with an abnormally high TCh concentration may result from an increased synthesis of other compounds that are capable of crossing the placental barrier. Other research groups reported a positive correlation between the maternal triglyceride concentration and the weight or fat mass of the newborn in pregnancies with gestational diabetes mellitus [9,41,42] or with overweight and obese mothers with gestational diabetes mellitus [43]. Our results show no correlation between the maternal triglyceride concentration, as well as for any of the lipoproteins analyzed in this study, and the newborn weight from normal pregnancies (i.e., without diagnosis of gestational diabetes mellitus or obesity).…”

The Childhood Obesity Epidemic as a Result of Nongenetic Evolution: The Maternal Resources Hypothesis

“…Because SM is the principal tissue for both insulin-mediated glucose disposal 17 and fatty acid oxidation 18 and an essential element of energy metabolism, 80 the progressive reductions in maternal PA and PAEE over the past century would result in progressive decrements in metabolic, 17,29,31,81–83 glycemic, 83–85 and lipidemic control. 86–88 This loss of metabolic control led to both transient hyperglycemia (i.e., glycemic excursions) and hyperlipidemia, 89–91 the former driven by reductions in insulin signaling resulting from replete myocyte glycogen stores, 92,93 and the latter from reduced SM energy demands and consequent decrements in total fatty acid oxidation, 86–88,94 increments in hepatic and adipocyte de novo lipogenesis, 95–97 and lipid accumulation in adipose tissue. 98,99 …”

“…103 I posit that the progressive reductions in maternal PA and PAEE and consequent reductions in SM activation over the past half century act synergistically with the naturally occurring metabolic sequelae of pregnancy (i.e., hormone-induced insulin resistance, increased adiposity) to exacerbate the negative metabolic consequences of inactivity 29,30,100,101 and drive fetal pathologies. The reductions in insulin sensitivity and increments in transient hyperglycemia and hyperlipidemia 91 substantially increase the availability of energy substrates to the intrauterine environment. Because the human placenta evolved in a context of intense competition between maternal resources and fetal demands (i.e., low to moderate maternal body mass and adiposity in concert with moderate to high levels of maternal EE, PA, and PAEE 104–106 ), the current context of high maternal resources in combination with low PA represents an evolutionary mismatch.…”

Association between preconceptional treatment with insulin pumps and improved metabolic status in early pregnancy in women with type 1 diabetes

“…17, 43 Such associations have also been observed in patients with gestational diabetes. 44,45 However, data on triglyceride levels during pregnancy in women with type 1 diabetes are limited. 13 There is a paucity of data from human trials exploring the role of CSII on the lipid profile in patients with type 1 diabetes.…”