The effects of lipid metabolism disorders (LMD) on pregnancy outcomes is not well known. The purpose of this study is to evaluate the impact of LMD on maternal and fetal outcomes.
Using the Healthcare Cost and Utilization Project – National Inpatient Sample from the United States, we carried out a retrospective cohort study of all births between 1999 and 2015 to determine the risks of complications in pregnant women known to have LMDs. All pregnant patients diagnosed with LMDs between 1999 and 2015 were identified using the International Classification of Disease-9 coding, which included all patients with pure hypercholesterolemia, pure hyperglyceridemia, mixed hyperlipidemia, hyperchylomicronemia, and other lipid metabolism disorders. Adjusted effects of LMDs on maternal and newborn outcomes were estimated using unconditional logistic regression analysis.
A total of 13,792,544 births were included, 9,666 of which had an underlying diagnosis of LMDs for an overall prevalence of 7.0 per 10,000 births. Women with LMDs were more likely to have pregnancies complicated by diabetes, hypertension, and premature births, and to experience myocardial infarctions, venous thromboembolisms, postpartum hemorrhage, and maternal death. Their infants were at increased risk of congenital anomalies, fetal growth restriction, and fetal demise.
Women with LMDs are at significantly higher risk of adverse maternal and newborn outcomes. Prenatal counselling should take into consideration these risks and antenatal care in specialized centres should be considered.
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: This study was solely based on a preexisting database from the United States that is freely available to the public: Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS).
Ethical approval: The local Institutional Review Board deemed the study exempt from review.
2. Chiang, AN, Yang, ML, Hung, JH, Chou, P, Shyn, SK, Ng, HT. Alterations of serum lipid levels and their biological relevances during and after pregnancy. Life Sci 1995;56:2367–75. https://doi.org/10.1016/0024-3205(95)00230-4. Search in Google Scholar
3. Nascimento, IBD, Dienstmann, G, Souza, MLR, Silva, TRE, Fleig, R, Silva, JC. Dyslipidemia and maternal obesity: prematurity and neonatal prognosis. Rev Assoc Med Bras 2018;64:264–71. https://doi.org/10.1590/1806-9282.64.03.264. Search in Google Scholar
4. Grimes, SB, Wild, R. Effect of pregnancy on lipid metabolism and lipoprotein levels. In: Feingold, KR, Anawalt, B, Boyce, A, Chrousos, G, de Herder, WW, Dungan, K, et al.. editors. Endotext. South Dartmouth (MA). MDText.com, Inc. Copyright © 2000–2020, MDText.com, Inc.; 2000. Search in Google Scholar
6. Vrijkotte, TG, Krukziener, N, Hutten, BA, Vollebregt, KC, van Eijsden, M, Twickler, MB. Maternal lipid profile during early pregnancy and pregnancy complications and outcomes: the ABCD study. J Clin Endocrinol Metab 2012;97:3917–25. https://doi.org/10.1210/jc.2012-1295. Search in Google Scholar
7. Maymunah, AO, Kehinde, O, Abidoye, G, Oluwatosin, A. Hypercholesterolaemia in pregnancy as a predictor of adverse pregnancy outcome. Afr Health Sci 2014;14:967–73. https://doi.org/10.4314/ahs.v14i4.28. Search in Google Scholar
8. Ghodke, B, Pusukuru, R, Mehta, V. Association of lipid profile in pregnancy with preeclampsia, gestational diabetes mellitus, and preterm delivery. Cureus 2017;9:e1420. https://doi.org/10.7759/cureus.1420. Search in Google Scholar
9. Jin, WY, Lin, SL, Hou, RL, Chen, XY, Han, T, Jin, Y, et al.. Associations between maternal lipid profile and pregnancy complications and perinatal outcomes: a population-based study from China. BMC Pregnan Childbirth 2016;16:60. https://doi.org/10.1186/s12884-016-0852-9. Search in Google Scholar
10. Smith, CJ, Baer, RJ, Oltman, SP, Breheny, PJ, Bao, W, Robinson, JG, et al.. Maternal dyslipidemia and risk for preterm birth. PLoS One 2018;13:e0209579. https://doi.org/10.1371/journal.pone.0209579. Search in Google Scholar
11. Gu, J, Karmakar-Hore, S, Hogan, M-E, Azzam, HM, Barrett, JFR, Brown, A, et al.. Examining cesarean section rates in Canada using the modified Robson classification. J Obstet Gynaecol Can 2020;42:757–65. https://doi.org/10.1016/j.jogc.2019.09.009. Search in Google Scholar
13. Ismail, S, Wong, C, Rajan, P, Vidovich, MI. ST-elevation acute myocardial infarction in pregnancy: 2016 update. Clin Cardiol 2017;40:399–406. https://doi.org/10.1002/clc.22655. Search in Google Scholar
16. Smilowitz, NR, Gupta, N, Guo, Y, Zhong, J, Weinberg, CR, Reynolds, HR, et al.. Acute myocardial infarction during pregnancy and the puerperium in the United States. Mayo Clin Proc 2018;93:1404–14. https://doi.org/10.1016/j.mayocp.2018.04.019. Search in Google Scholar
17. Hurtubise, J, McLellan, K, Durr, K, Onasanya, O, Nwabuko, D, Ndisang, JF. The different facets of dyslipidemia and hypertension in atherosclerosis. Curr Atherosclerosis Rep 2016;18:82. https://doi.org/10.1007/s11883-016-0632-z. Search in Google Scholar
18. Tietge, UJ. Hyperlipidemia and cardiovascular disease: inflammation, dyslipidemia, and atherosclerosis. Curr Opin Lipidol 2014;25:94–5. https://doi.org/10.1097/mol.0000000000000051. Search in Google Scholar
20. Charlton, F, Tooher, J, Rye, KA, Hennessy, A. Cardiovascular risk, lipids and pregnancy: preeclampsia and the risk of later life cardiovascular disease. Heart Lung Circ 2014;23:203–12. https://doi.org/10.1016/j.hlc.2013.10.087. Search in Google Scholar
21. Spracklen, CN, Smith, CJ, Saftlas, AF, Robinson, JG, Ryckman, KK. Maternal hyperlipidemia and the risk of preeclampsia: a meta-analysis. Am J Epidemiol 2014;180:346–58. https://doi.org/10.1093/aje/kwu145. Search in Google Scholar
22. Wetzka, B, Winkler, K, Kinner, M, Friedrich, I, Marz, W, Zahradnik, HP. Altered lipid metabolism in preeclampsia and HELLP syndrome: links to enhanced platelet reactivity and fetal growth. Semin Thromb Hemost 1999;25:455–62. https://doi.org/10.1055/s-2007-994950. Search in Google Scholar
23. Barrett, HL, Dekker Nitert, M, McIntyre, HD, Callaway, LK. Maternal lipids in pre-eclampsia: innocent bystander or culprit? Hypertens Pregnan 2014;33:508–23. https://doi.org/10.3109/10641955.2014.946614. Search in Google Scholar
24. Magee, LA, Pels, A, Helewa, M, Rey, E, von Dadelszen, P. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can 2014;36:575–6. https://doi.org/10.1016/s1701-2163(15)30533-8. Search in Google Scholar
25. Christensen, JJ, Retterstol, K, Godang, K, Roland, MC, Qvigstad, E, Bollerslev, J, et al.. LDL cholesterol in early pregnancy and offspring cardiovascular disease risk factors. J Clin Lipidol 2016;10:1369–78.e7. https://doi.org/10.1016/j.jacl.2016.08.016. Search in Google Scholar
26. Sattar, N, Greer, IA, Galloway, PJ, Packard, CJ, Shepherd, J, Kelly, T, et al.. Lipid and lipoprotein concentrations in pregnancies complicated by intrauterine growth restriction. J Clin Endocrinol Metab 1999;84:128–30. https://doi.org/10.1210/jcem.84.1.5419. Search in Google Scholar
28. Lemstra, M, Rogers, M, Moraros, J. Income and heart disease: neglected risk factor. Can Family Phys Med Famille Canadien 2015;61:698–704. Search in Google Scholar
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