Mediating effect of lipid levels during first trimester of pregnancy between COVID-19 lockdown and gestational diabetes mellitus

Abstract

Background Higher triglycerides (TG) levels are associated with gestational diabetes mellitus (GDM) and higher prevalence of GDM was found in women experiencing COVID-19 pandemic lockdown in early pregnancy. This study aimed to explore the relationship among lockdown, lipid levels change in the first trimester and GDM. Methods This was a population-based observational cohort study. Mean values of lipid levels were compared by Wilcoxon rank-sum test. Logistic regression analysis was used to analyze the effects of lockdown and lipid profile on GDM. Mediation analysis was performed to identify whether blood lipid level mediated the association between lockdown and GDM. Results A total of 3997 pregnant women were included, among whom 614 (15.36%) were defined as GDM group and 3383 (84.64%) were defined as non-GDM group. Women who experienced lockdown in the first trimester had higher levels of serum total cholesterol (TC), TG, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) (p < 0.001) than others. Besides, experiencing lockdown (OR 1.84, 95% CI 1.50-2.26) and higher level of TG (OR 1.34, 95% CI 1.16-1.55) during the first trimester were both significantly and independently associated with the risk of GDM by multivariate logistic regression analysis. Furthermore, mediation analysis was conducted to explore the potential relationship among lockdown, lipid levels change during the first trimester and GDM,which showed TG played a mediating role in the association between lockdown and GDM (p < 0.001). Conclusions Pregnant women who experienced lockdown had higher levels of TC, TG HDL and LDL in the first trimester.TG had a mediating effect between lockdown and GDM, indicating that lockdown which brought physical inactivity and poor diet in early pregnancy may have an effect on the development of GDM by affecting lipid profile. Therefore, exercise and diet interventions in early pregnancy could help prevent GDM.