The Correlation Between Blood Lipid Levels In The Second Trimester Of Pregnancy And Fetal Macrosomia

Objective:To investigate blood lipid levels in the second trimester in Wuhan and particularly analyze the association between maternal blood lipid levels in second trimester and the risks of fetal macrosomia.Subjects and Methods:From January 2013 to May 2016,the pregnant women in the first trimester who planned to do systemic antenatal care and deliver at the same hospitals would be invited to attend Tongji Maternal and Child Health Cohort study（TMCHC）.As their first visiting,we investigated maternal information including demographic characteristic,lifestyle data and disease history by questionnaire survey.During 16-19 weeks gestation,pregnant women were collected fasting bloods.Their serum levels of total cholesterol（TC）,triglyceride（TG）,high density lipoprotein cholesterol（HDL-C）,and low density lipoprotein cholesterol（LDL-C）would be measured.We investigated prenatal weight,neonatal weight,neonatal gender and gestational age at birth from hospital medical records.This analysis was involved in the pregnant women who were 18-42 years old and had possessed the normal blood glucose,blood pressure,blood lipid and liver functions in pre-gestation from TMCHC study,and were excluded the pregnant women who received pharmacotherapy in early pregnancy which influenced their serum lipids levels,and who had postdates gestation or delivered premature or low birth weight infant.The lipid levels were expressed as P₅₀(P₂₅,P₇₅).（34）² test was used to find the influencing factors of macrosomia.Log-binomial regression was used to calculate relative risk（RR）and 95%confidence interval（CI）.The serum lipid levels were categorized according to quartiles of their distributions.The categorized group were named Q4,Q3,Q2,Q1 from high to low.The Q1 was reference group.The elderly women were over 35 years old.The pregnant women who were neither elderly nor overweight in pre-gestation and hadn’t got gestational diabetes mellitus were made sensitivity analysis.Then stratified analysis was stratified by the height 160 cm.The clinical diagnosis value of serum lipid levels in the second trimester was evaluated by receiver operating characteristic curve（ROC）analysis.Results:Following inclusion and exclusion criteria,2249 pregnant women were involved to analyze,of which 144 pregnant women delivered fetal macrosomia（6.4%）.Their average age was 28±3 years old and average height was 160.3±5.1 cm.Their average pre-pregnancy body mass index（BMI）was 20.7±2.6 kg/m² and 62.8%got too more pregnancy weight gain（GWG）.56.5%had bachelor degree or above.The average gestational age of newborn was 39.3±1.2 weeks,and 54.3%was boy.The serum TG level was 1.57（1.26,2.01）mmol/L.The serum TC level was 4.76（4.20,5.39）mmol/L.The serum HDL-C level was 1.65（1.08,2.02）mmol/L.The serum LDL-C level was 2.45（1.89,3.09）mmol/L.When adjusted by infant gender and gestational age at birth,Q3 vs Q1 of TG:RR=1.80,95%CI:1.10-2.95,Q4 vs Q1 of TG:RR=2.10,95%CI:1.30-3.39.When adjusted by pre-pregnancy BMI,maternal age,educational level and GWG,Q3 vs Q1 of TG:RR=1.71,95%CI:1.03-2.83,Q4 vs Q1 of TG:RR=1.67,95%CI:1.02-2.76.In the sensitivity analysis,the women with higher serum TG level during the second trimester of pregnancy were also found that they had higher risk for development of fetal macrosomia.The area under the ROC of TG was 0.588,95%CI:0.541-0.635.The optimal cut-off points of the TG to detect fetal macrosomia was 1.47 mmol/L.Furthermore,the area under the ROC of TG combined with pre-pregnancy BMI and GWG was 0.739,95%CI:0.700-0.778.Conclusions:The serum TG level in the second trimester was independent risk factors for fetal macrosomia.The results suggested that women with higher serum TG level during the second trimester of pregnancy had higher risk for development of fetal macrosomia.The serum TC,HDL-C,LDL-C levels in the second trimester were not associated with the fetal macrosomia incidence.When the serum TG level in the second trimester is greater than 1.47 mmol/L,there is an urgent need for ongoing monitoring of the serum TG level in order to reduce the fetal macrosomia incidence.