Physiologic and supraphysiologic increases in lipoprotein lipids and apoproteins in late pregnancy and postpartum. Possible markers for the diagnosis of "prelipemia".

Abstract

A supraphysiologic (>95th percentile) rise in plasma lipids in pregnancy may serve as a marker for "prelipemia" in the same way that gestational diabetes is a marker for prediabetes. To qualify as prelipemic, subjects with an abnormal lipid rise antepartum must return to normal postpartum but may have other identifying characteristics. This paper describes the antepartum-postpartum changes of lipoprotein lipids and apoproteins at 34 to 38 weeks of gestation and 6 and 20 weeks postpartum in 23 subjects with physiologic and six subjects with supraphysiologic plasma lipid increases during pregnancy. These results are compared to measurements in 23 nonpregnant controls matched for weight, age, and race. In subjects with a physiologic antepartum lipid rise, postpartum total triglyceride and very low density lipoprotein (VLDL) lipids (cholesterol and triglyceride) and apo B returned to baseline within 6 weeks. 12 With respect to glucose homeostasis, it is well known that some women manifest overt diabetes under the stress of pregnancy but revert to normal after delivery. The deterioration of glucose homeo- Received August 17, 1983; revision accepted March 14, 1984. stasis in pregnancy, known as gestational diabet e s , 1 3 4 is considered to be a form of prediabetes because it predicts later progression to overt diabetes with a high degree of accuracy. 4 It is not yet known if a similar deterioration of lipid homeostasis occurs in pregnancy, reverts to normal postpartum, and predicts the appearance of overt nongestational hyperlipidemia years later. Such a condition might be termed "prelipemia" and if identified would provide an important tool to study the natural history of hyperlipidemia from its earliest stages. This paper presents information to support the hypothesis that prelipemia is identified by a supraphysiologic lipid rise in pregnancy. The postpartum return of plasma lipids and lipoproteins to baseline is described in normal subjects. These results are compared to women with supraphysiologic elevations in triglyceride or cholesterol in pregnancy but with de-407 by guest on May 11, 2018 http://atvb.ahajournals.org/ Downloaded from

Maternal Hypercholesterolemia During Pregnancy Promotes Early Atherogenesis in LDL Receptor-Deficient Mice and Alters Aortic Gene Expression Determined by Microarray

“…The relative increase in the control group compared with prepregnancy levels was reminiscent of increased cholesterol levels during the third trimester in human mothers. 27 Triglyceride levels showed an analogous rise to 120 and 124 mg/dL in the 0.075% and 1.25% cholesterol groups, respectively, compared with 52 mg/dL in the control group (PϽ0.001) ( Figure 2B). Body weights, plasma cholesterol, and triglycerides in male offspring at 3 months old are shown in Table 1.…”

Managing Preexisting Diabetes for Pregnancy

“…When triglyceride levels are Ն200 mg/dl, non-HDL cholesterol becomes a secondary target (Ͻ130 mg/dl) of cholesterol-lowering therapy (12-14). In normal pregnancy the triglyceride level may double by 20 weeks' gestation, and cholesterol, LDL cholesterol, and HDL cholesterol increase by 10 -20%, with further progression of all lipid levels until term (165). Triglyceride levels may increase much more in pregnancy complicated by type 2 diabetes, and exaggerated hypertriglyceridemia (Ͼ2,000 mg/ dl) presents a seriously increased risk for pancreatitis.…”

The Importance of Lipid and Lipoprote in Ratios in Interpretetions of Hyperlipidaemia of Pregnancy

“…In addition, in similarity with other gestational metabolic syndromes such as gestational diabetes mellitus (GDM), pregnancyinduced hypertension (PIH), pre-eclampsia, eclampsia, etc, some of them may develop a state of Supraphysiologic hyperlipidaemia, defined as lipid levels greater than 95 th percentile for the corresponding gestational age, because of failed adaptation to requirement of pregnancy. Supraphysiologic hyperlipidaemia may serve as a marker for what is cited by Montes [99], et al, a 'prelipaemia' in the same way that GDM is a marker for pre-diabetes.…”

“…The characteristics of Supraphysiologic hyperlipidaemia, as observed by Montes [99], et al, are that, the antepartum hyperlipidaemia may return to normal levels postpartum more slowly than normal, the presence of HDL cholesterol concentrations that are persistently low antepartum and postpartum, and the patients do have hyperlipidaemic family members. In contrast, hypercholesterolemia is not greatly exaggerated in pregnancy among these women.…”