Association between second and third trimester maternal lipid profiles and adverse perinatal outcomes among women with gestational diabetes mellitus: A retrospective cohort study

Abstract

Abstract Background: Lipid metabolism disorder during pregnancy has been reported in women with gestational diabetes mellitus (GDM). However, some controversy remains regarding the relationship between maternal dyslipidemia and perinatal outcomes. The aim of this study was to investigate the association between maternal lipid levels and adverse perinatal outcomes in women with GDM. Methods: Total 1755 pregnant women with GDM who delivered between 2011–2021 were enrolled in this study. Serum samples were assayed for fasting total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels during the second and third trimesters of pregnancy. Adjusted odds ratios (AOR) and 95% confidence intervals (95 % CI) were calculated via stepwise multivariable logistic regression analysis to determine the association of lipid levels with perinatal outcomes. Results: The serum TC, TG, LDL, and HDL levels in third trimester were significantly higher than those in second trimester(p<0.001). Women with GDM had significantly higher levels of TC and TG in second and third trimesters compared with women without GDM in the same trimesters, while HDL levels decreased in women with GDM. After adjusting for confounding factors by multivariate logistic regression, every mmol/L elevation in TG levels in second and third trimesters was associated with a higher risk of caesarean section(AOR=1.241, 95% CI: 1.103–1.396, p<0.001; AOR=1.716, 95% CI: 1.556–1.921, p<0.001), large for gestational age infants (AOR=1.419, 95% CI: 1.173–2.453, p=0.001; AOR=2.011, 95% CI: 1.673–2.735, p<0.001), macrosomia (AOR=1.220, 95%CI: 1.133–1.643, p=0.005; AOR=1.891, 95% CI: 1.322–2.519, p<0.001), and neonatal unit admission (AOR=1.781, 95% CI: 1.267–2.143, p<0.001; AOR=2.052, 95% CI: 1.811–2.432, p<0.001). Additionally, every mmol/L increase in second and third trimester HDL levels was associated with decreased risk of large for gestational age infants (AOR=0.478, 95% CI: 0.329–0.879, p=0.008; AOR=0.599, 95% CI: 0.321–0.783, p=0.017) and neonatal unit admission (AOR=0.575, 95% CI: 0.311–0.722, p=0.012; AOR=0.322, 95% CI: 0.178–0.599, p=0.001). Conclusions: Among women with GDM, dyslipidemia in second and third trimesters was related to adverse perinatal outcomes, suggesting the importanceof monitoring second and third trimester lipid profiles in improving clinical outcomes in GDM pregnancies.