Maternal plasma cholesterol and duration of pregnancy: A prospective cohort study in Ghana

Abstract

Low plasma cholesterol may be associated with preterm birth; however, results are mixed and limited primarily to high‐income countries. Our objective was to determine whether maternal plasma lipid concentrations are associated with pregnancy duration. We performed a nested cohort (n = 320) study of pregnant Ghanaian women enrolled in a randomized controlled trial. Total cholesterol, high‐density lipoprotein cholesterol (HDL‐C), low‐density lipoprotein cholesterol, and triglyceride concentrations were analyzed in plasma at ≤20and 36 weeks gestation as continuous variables and also categorized into low, referent, or high (<10th, 10th–90th, >90th percentile). At ≤20 weeks, plasma lipid concentrations were not associated with pregnancy duration. At 36 weeks, total cholesterol and triglyceride concentrations were not associated with pregnancy duration. Higher HDL‐C at 36 weeks was associated with a longer pregnancy duration (adjusted β‐coefficient ± standard error: 0.05 ± 0.02 days mg−1/dL, p = .02); pregnancy duration was 5.9 ± 2.0 (mean ± standard error) days shorter among women with low HDL‐C compared with the referent group (10th–90th percentile) (p = .02) and 8.6 ± 2.6 days shorter when compared with the high HDL‐C group (p = .003). Pregnancy duration was 4.9 ± 2.1 days longer among women with low low‐density lipoprotein cholesterol at 36 weeks gestation when compared with the referent group (p = .051). Our data suggest that low HDL‐C in the third trimester of pregnancy is associated with a shorter duration of pregnancy in this study population but do not support the hypothesis that low total cholesterol is associated with a shorter pregnancy duration.

Maternal plasma lipid levels across pregnancy and the risks of small-for-gestational age and low birth weight: a cohort study from rural Gambia

“…These findings suggest that dietary interventions to improve diet and increase cholesterol levels during pregnancy may promote fetal growth and reduce adverse birth weight-related outcomes. Consistent with previous studies, we observed an increase in plasma TC, LDL-c and TG levels across pregnancy [10,16,17,26,27], which is known to be part of a normal physiological response to gestation [28]. However, unlike in studies from higher-income countries [10,27,28], our data show a decrease in HDL-c levels from 20 to 30 weeks gestation, following an initial rise across the first half of pregnancy.…”

“…In this cohort of pregnant women from rural Gambia, plasma lipid levels were lower compared to those reported in studies from high-income countries [26][27][28][29] or urban areas in LMICs [30], likely reflecting the typical diet in rural Gambia which is low in animal-source foods and consists mainly of carbohydrate-rich staple foods. Low HDL-c levels in the first half of pregnancy were associated with three times the risk of LBW.…”

“…Low HDL-c levels in non-pregnant populations have been associated with atherogenic lipid profiles and higher risks of cardiovascular disease and mortality [32][33][34]. During pregnancy, low HDL-c levels have been linked to greater risks of adverse pregnancy outcomes [35], including preterm birth [36], a shorter pregnancy length [27] and preeclampsia [35,37]. One of the main functions of HDL is to promote reverse cholesterol transport from peripheral tissues to the liver for excretion in bile acids.…”

Lipid-Based Nutrient Supplementation Increases High-Density Lipoprotein (HDL) Cholesterol Efflux Capacity and Is Associated with Changes in the HDL Glycoproteome in Children

“…In the United States, low maternal HDL cholesterol (HDL-C) was associated with a low birth weight z-score, 10 and in Ghana, we previously reported that high HDL-C at 36 weeks gestation was positively associated with the duration of gestation. 11 Even less is known about HDL particles, particularly in infants; however, limited evidence in preterm infants indicates that a lower concentration of HDL particles is found in infants with chronic lung disease compared to those without lung disease. 12 HDL particles display a variety of immunomodulatory capabilities, 13 including boosting the ability of innate immune cells to fight infection, 14 and may thus be particularly important in settings with high infection burden.…”

“…Very little is known about the role of HDL during pregnancy and in early development. In the United States, low maternal HDL cholesterol (HDL-C) was associated with a low birth weight z-score, and in Ghana, we previously reported that high HDL-C at 36 weeks gestation was positively associated with the duration of gestation . Even less is known about HDL particles, particularly in infants; however, limited evidence in preterm infants indicates that a lower concentration of HDL particles is found in infants with chronic lung disease compared to those without lung disease .…”