Study On The Associations Between Maternal Serum Lipids And Pregnancy Outcomes

Background:Maternal blood lipids elevated by the maternal endogenous hormone changes during pregnancy physiologically to meet the needs of fetal growth and development.But more and more studies have shown that elevated blood lipids will increase the incidence of adverse pregnancy outcomes.But the results of the study are not uniform.And the pathogenesis has not reached a consensus.This study was to investigate the effect of gestational serum levels on pregnancy complications and pregnancy outcomes in order to reduce the adverse pregnancy outcomes by controlling maternal blood lipids during pregnancy.Methods:Clinical datas of pregnant women delivered singleton baby after 28 gestational weeks in Women’s Hospital School of Medicine Zhejiang University from January 1,2014 to December 31,2014 were collected,excluding those pregravid heart disease,diabetes,hypertension,thyroid dysfunction,polycystic ovary syndrome,abnormal liver function autoimmune diseases and other medical history of important organ disease.A total go 9924 women were taken into this research and were measured in the second trimester(24-27 week),late pregnancy(≥ 28 week)serum lipids,including total cholesterol,triglycerides,low density lipoprotein-cholesterol and high density lipoprotein-cholesterol.According to the guidelines of "Chinese Adult Dyslipidemia Prevention and Control guidelines(revised in 2016)" divided these women into normal serum lipid group and dyslipidemia group,compared the two groups of basic information,pregnancy complications and fetal perinatal outcomes respectively.Pregnancy complications include gestational diabetes mellitus(GDM),hpertensive disorder complication(HDCP)(including gestational hypertension,preeclampsia and eclampsia)and intrahepatic cholestasis of pregnancy(ICP);pregnancy outcomes include cesarean section,premature delivery,macrosomia,fetal distress and postpartum hemorrhage.Results:1.The incidence of dyslipidemia in pregnancy women was 91.12%,which was significantly higher than that of adult in China(40.40%)(P<0.05).2.The concentrations of TC,TG and LDL-C in the third trimester were significantly higher than those in the second trimester(6.66±1.27)v(6.22±1.03)mmol/L,(3.45±1.64)v(2.21±0.85)mmol/L,(3.68±1.00)v(3.43±0.85)mmol/L,P<0.05,and the concentration of HDL-C in the third trimester was significantly lower than that in the second trimester stage(2.10±0.53)v(2.37±0.50)mmol/L,P<0.05.3.The mean age of the dyslipidemia group(29.5 ± 3.5y)was significantly higher than that of the normal group(28.9±3.4y);P<0.05.The average number of pregnancies in dyslipidemia group(1.77±1.01)was significantly higher than that of the normal group(1.68±0.99);P<0.05.There was no significant difference in BMI.increased weight during pregnancy and number of deliver between the normal group and the dyslipidemia group(P>0.05).4.The incidence of GDM was 15.16%in dyslipidemia group,which was significantly higher than that in normal group(10.90%.P<0.05),was 1.39 times as the normal group.The incidence of HDCP was 3.64%in dyslipidemia group,which was significantly higher than that in normal group(2.16%,P<0.05),was 1,68 times as the normal group.The incidence of ICP was not significantly different between the two groups.5.Higher concentration of TG increased he risk of GDM significantly both in the second and third trimester;higher concentration of LDL-C in the third trimester decreased the risk of GDM significantly(P<0.05).Higher concentration of TG increased he risk of HDCP significantly in the second trimester;higher concentration of TC in the third trimester decreased the risk of HDCP significantly(P<0.05).6.The incidence of cesarean section and macrosomia in dyslipidemia group were significantly higher than those in normal group(P<0.05);the incidence of fetal distress was significantly lower in the dyslipidemia group than in the normal group(P<0.05).The incidence of cesarean section and macrosomia in GDM group was significantly higher than that in normal pregnancy group(P<0.05).The incidence of cesarean section,premature deliver and macrosomia in HDCP group was significantly higher than that in normal pregnancy group(P<0.05).For normal pregnant women,the incidence of cesarean section and macrosomia in dyslipidemia group were significantly higher than those in normal group(P<0.05).Conclusions:(1)Gestational serum lipid was significantly higher than non-pregnant population,and with gestational age increased serum lipid concentrations gradually increased;(2)Dyslipidemia in the second and third trimester increased the incidence of GDM and HDCP of pregnant women;(3)TG is a risk factor for pregnant women with GDM and HDCP;(4)Elevated serum lipids increased the incidence of cesarean section and macrosomia;(5)Well managed serum lipid of pregnant women can reduce the incidence of pregnancy complications and adverse pregnancy outcomes.