Hypertensive Pregnancy Disorders and Lipid Profiles: A Cohort Study
DOI:
https://doi.org/10.31661/gmj.v11i.2395Keywords:
Preeclampsia, Lipids, Gestational Hypertension, PregnancyAbstract
Background: The global prevalence of hypertensive pregnancy disorders (HPDs) is 5.2%-8.2%. Lipid profiles made up of triglycerides (TG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL), and high-density lipoprotein-cholesterol (HDL) could affect the arterial vessel wall leading to HPDs. Preeclampsia (PE), among the most severe maternal-fetal HPDs, has affected 0.2%-9.2% of all pregnancies. The current study aimed to investigate the role of lipid profiles in predicting PE in the first and early third trimesters of pregnancy.
Material and Method: A large-scale prospective cohort study was conducted from early pregnancy onward in a normal population in the south of Iran. Fasting blood samples were examined for TG, TC, HDL, and LDL, as well as LDL/HDL ratio levels in the first and early third trimesters. Result: Of 486 pregnant women, 37 women developed HPDs, of which 20 (54%) developed PE. In the PE group, the levels of serum lipid profiles, including TG, TC, LDL, and HDL, significantly raised with gestational age (P<0.05). After adjusting for maternal age and body mass index, TG, TC, LDL, and LDL/HDL ratio levels were associated with a higher risk of PE (odds ratio [OR]=1.025, 1.035, 1.03, 2.08, and 1.026, 1.044, 1.03, 2.14, P<0.001) regarding the first and early third trimesters, respectively. The optimum cut-off points for TG, TC, LDL, and LDL/HDL ratios predicting PE were estimated to be 180.5 mg/dl, 197.5 mg/dl, 136 mg/dl, and 3.66 in the first, and 220 mg/dl, 204 mg/dl, 155.5 mg/dl, and 3.97 in the early third trimesters. Conclusion: Dyslipidemia during pregnancy may help predict PE development that can be sustained with lipid-lowering drugs. [GMJ.2022;11:e2395]
References
Umesawa M, Kobashi G. Epidemiology of hypertensive disorders in pregnancy: prevalence, risk factors, predictors and prognosis. Hypertens Res. 2017;40(3):213-20. https://doi.org/10.1038/hr.2016.126PMid:27682655 Abalos E, Cuesta C, Grosso AL, Chou D, Say L. Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):1-7. https://doi.org/10.1016/j.ejogrb.2013.05.005PMid:23746796 Goldenberg RL, Jones B, Griffin JB, Rouse DJ, Kamathâ€Rayne BD, Trivedi N, et al. Reducing maternal mortality from preeclampsia and eclampsia in lowâ€resource countries-what should work? Acta Obstet Gynecol Scand. 2015;94(2):148-55. https://doi.org/10.1111/aogs.12533PMid:25353716 Dassah ET, Kusi-Mensah E, Morhe ES, Odoi AT. Maternal and perinatal outcomes among women with hypertensive disorders in pregnancy in Kumasi, Ghana. PloS One. 2019;14(10):e0223478. https://doi.org/10.1371/journal.pone.0223478PMid:31584982 PMCid:PMC6777792 Karatza AA, Dimitriou G. Preeclampsia Emerging as a Novel Risk Factor for Cardiovascular Disease in the Offspring. Curr Pediatr Rev. 2020;16(3):194-9. https://doi.org/10.2174/18756336MTAzlMTg3yhttps://doi.org/10.2174/1573396316666191224092405PMid:31884930 PMCid:PMC8193805 Kongwattanakul K, Saksiriwuttho P, Chaiyarach S, Thepsuthammarat K. Incidence, characteristics, maternal complications, and perinatal outcomes associated with preeclampsia with severe features and HELLP syndrome. Int J Womens Health. 2018;10:371-7. https://doi.org/10.2147/IJWH.S168569PMid:30046254 PMCid:PMC6054275 Maged AM, Elsherief A, Hassan H, Salaheldin D, Omran KA, Almohamady M, et al. Maternal, fetal, and neonatal outcomes among different types of hypertensive disorders associating pregnancy needing intensive care management. J Matern Fetal Med. 2020;33(2):314-21. https://doi.org/10.1080/14767058.2018.1491030PMid:29914278 Tranquilli AL, Dekker G, Magee L, Roberts J, Sibai BM, Steyn W, et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP. Pregnancy Hypertens. 2014;4(2):97-104. https://doi.org/10.1016/j.preghy.2014.02.001PMid:26104417 Wang C, Kong L, Yang Y, Wei Y, Zhu W, Su R, et al. Recommended reference values for serum lipids during early and middle pregnancy: a retrospective study from China. Lipids Health Dis. 2018;17(1):1-16. https://doi.org/10.1007/978-981-13-0620-4_1https://doi.org/10.1186/s12944-015-0172-5https://doi.org/10.1186/s12944-018-0885-3https://doi.org/10.1186/s12944-018-0950-yPMid:30611256 PMCid:PMC6320598 Singh A, Kujur A, Jain P. Feto-maternal impact of altered lipid profile in pregnancy. Int J Reprod Contracept Obstet Gynecol. 2018;7(1):132-7. https://doi.org/10.18203/2320-1770.ijrcog20175547 Ghodke B, Pusukuru R, Mehta V. Association of Lipid Profile in Pregnancy with Preeclampsia, Gestational Diabetes Mellitus, and Preterm Delivery. Cureus. 2017;9(7):e1420. https://doi.org/10.7759/cureus.1420PMid:28875093 PMCid:PMC5580975 Garcia MS, Mobley Y, Henson J, Davies M, Skariah A, Dambaeva S, et al. Early pregnancy immune biomarkers in peripheral blood may predict preeclampsia. J Reprod Immunol. 2018;125:25-31. https://doi.org/10.1016/j.jri.2017.10.048PMid:29161617 Staff A, Dechend R, Redman C. Preeclampsia, acute atherosis of the spiral arteries and future cardiovascular disease: two new hypotheses. Placenta. 2013;34:S73-8. https://doi.org/10.1016/j.placenta.2012.11.022PMid:23246096 Alonso-Ventura V, Li Y, Pasupuleti V, Roman YM, Hernandez AV, Pérez-López FR. Effects of preeclampsia and eclampsia on maternal metabolic and biochemical outcomes in later life: a systematic review and meta-analysis. Metabolism. 2020;102:154012. https://doi.org/10.1016/j.metabol.2019.154012PMid:31734276 Adank MC, Benschop L, Peterbroers KR, Smak Gregoor AM, Kors AW, Mulder MT, Schalekamp-Timmermans S, Roeters Van Lennep JE, Steegers EAP. Is maternal lipid profile in early pregnancy associated with pregnancy complications and blood pressure in pregnancy and long term postpartum? Am J Obstet Gynecol. 2019;221(2):150.e1-13. https://doi.org/10.1016/j.ajog.2019.03.025PMid:30940559 Esteve-Valverde E, Ferrer-Oliveras R, Gil-Aliberas N, Baraldes-Farre A, Llurba E, Alijotas-Reig J. Pravastatin for Preventing and Treating Preeclampsia: A Systematic Review. Obstet Gynecol Surv. 2018;73(1):40-55. https://doi.org/10.1097/OGX.0000000000000522PMid:29368790 Bauersachs J, König T, Van Der Meer P, Petrie MC, Hilfikerâ€Kleiner D, Mbakwem A, et al. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail. 2019;21(7):827-43. https://doi.org/10.1002/ejhf.1493PMid:31243866 Motedayen M, Rafiei M, Tavirani MR, Sayehmiri K, Dousti M. The relationship between body mass index and preeclampsia: A systematic review and meta-analysis. Int J Reprod Biomed. 2019;17(7):463. https://doi.org/10.18502/ijrm.v17i7.4857PMid:31508571 PMCid:PMC6718883 Poorolajal J, Jenabi E. The association between body mass index and preeclampsia: a meta-analysis. J Matern Fetal Neonatal Med. 2016;29(22):3670-6. https://doi.org/10.3109/14767058.2016.1140738PMid:26762770 Jin W-Y, Lin S-L, Hou R-L, Chen X-Y, Han T, Jin Y, et al. Associations between maternal lipid profile and pregnancy complications and perinatal outcomes: a population-based study from China. BMC Pregnancy Childbirth. 2016;16(1):1-9. https://doi.org/10.1186/s12884-016-0852-9PMid:27000102 PMCid:PMC4802610 Kumari K, Singh U, Maharshi S, Singh R. Assessment of serum lipid profile in early pregnancy and its relation with pre eclampsia: a prospective study. Int J Reprod Contracept Obstet Gynecol. 2016;5(3):840-5. https://doi.org/10.18203/2320-1770.ijrcog20160595 Zheng T, Ye W, Wang X, Li X, Zhang J, Little J, et al. A simple model to predict risk of gestational diabetes mellitus from 8 to 20 weeks of gestation in Chinese women. BMC Pregnancy Childbirth. 2019;19(1):1-10. https://doi.org/10.1186/s12884-019-2374-8PMid:31324151 PMCid:PMC6642502 Chopra S, Pahwa S. Role of lipid profile and uterine artery doppler in predicting risk of preeclampsia in early second trimester. Int J Reprod Contracept Obstet Gynecol. 2020;9(5):1806-13. https://doi.org/10.18203/2320-1770.ijrcog20201542 https://doi.org/10.4103/ijabmr.IJABMR_271_19PMid:32002386 PMCid:PMC6967338 Pendli G, Chandana G, Balaji S, Varaprasad MD. A study of biochemical parameters in pregnant women in III trimester with non-alcoholic fatty liver disease (NAFLD). Biomedicine. 2021;41(2):199-205. https://doi.org/10.51248/.v41i2.784 Tesfa E, Nibert E, Munshea A. Maternal lipid profile and risk of pre-eclampsia in African pregnant women: A systematic review and meta-analysis. PLoS One. 2020;15(12):e0243538. https://doi.org/10.1371/journal.pone.0243538PMid:33362205 PMCid:PMC7757810 Thathagari V, Kumar VJIJRCOG. Evaluation of serum lipids in preeclampsia: a comparative study. Int J Reprod Contracept Obstet Gynecol. 2018;7(4):1372-5. https://doi.org/10.18203/2320-1770.ijrcog20180998 Yadav S, Agrawal M, Hariharan C, Dewani D, Vadera K, Krishna NJJoDMIoMSU. A comparative study of serum lipid profile of women with preeclampsia and normotensive pregnancy. J Obstet Gynaecol India. 2018;13(2):83. https://doi.org/10.4103/jdmimsu.jdmimsu_70_17 Majhi B. Role of lipid profile in early second trimester for prediction of pre-eclampsia. Int J Reprod Contracept Obstet Gynecol. 2021;10(8):3101-6. https://doi.org/10.18203/2320-1770.ijrcog20212962 Yadav K, Aggarwal S, Verma K. Serum βhCG and lipid profile in early second trimester as predictors of pregnancy-induced hypertension. J Obstet Gynaecol India. 2014;64(3):169-74. https://doi.org/10.1007/s13224-013-0490-3PMid:24966499 PMCid:PMC4061328
