Revisiting weight gain during gestation: body mass index and weight gain are associated with increased maternal cholesterol levels and higher risk of maternal supraphysiological hypercholesterolemia

Abstract

Background Total cholesterol (TC) and low-density lipoproteins (LDL) increase during pregnancy, in order to ensure fetal development. However, some women present maternal supraphysiological hypercholesterolemia (MSPH), or lipid levels over the 75th percentile, in the third trimester of pregnancy (T3). Despite this condition being associated with vascular dysfunction in the mother and the offspring, clinical reference values for lipid levels in pregnancy, and the impact of nutritional status on lipid profile – from pre-gestational (PG) until postpartum period (PP) – or on the onset of MSPH are unknown. Aim To determine if lipid levels at PG, pregnancy, and PP are influenced by maternal nutritional status, including body mass index (BMI) and weight gain during pregnancy (WG), and if these factors are associated with MSPH. Methods This study included data from 650 women categorized as normal weight (NW), overweight (OW), and with obesity (OB), according to the nutritional status, considering the BMI at T1. Lipid profiles (TC, LDL, HDL, and triglycerides (TG)) were analyzed at PG, T1, T2, T3, and PP. The percentiles for the different lipids and nutritional status were estimated. Correlations, and linear and logistic regressions were performed, considering lipids and weight parameters. Estimated probabilities for MSPH were also calculated. Results All women in our sample presented increased TC, LDL, and TG at T2, T3, and PP, in comparison to PG. Regarding nutritional status, women with OB presented reduced TC and LDL levels at T3 compared to NW women. TC and LDL at T3 were negatively correlated and associated with BMI at T3, while they were positively correlated and associated with WG. The logistic regression showed that WG is positively associatd with MSPH. Furthermore, the increase in WG is associated with an increased estimated probability for a woman having MSPH, and reaches 68.7% for a 30-kg WG. Conclusion The TC and LDL levels at T3 were directly related to weight parameters, and higher WG increased the risk for MSPH.