Journal Reading Fetomaternal Division

Is maternal lipid profile in early pregnancy associated

with pregnancy complications and blood pressure in
pregnancy and long term postpartum?
Maria C. Adank, MD1; Laura Benschop, MD, PhD1; Kelly R. Peterbroers;
Anna M. Smak Gregoor; Alet W. Kors; Monique T. Mulder, PhD;
Sarah Schalekamp-Timmermans, MD, PhD; Jeanine E. Roeters Van Lennep, MD, PhD; Eric A. P. Steegers, MD, PhD

Materials & Methods

Background
Conclusion

Comment

Results

Presented by:
dr. Tian Kaprianti

Moderator :
Dr. H. Wim T. Pengemanan,SpOG(K)

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

FACULTY OF MEDICINE SRIWIJAYA UNIVERSITY
DR. MOHAMMAD HOESIN GENERAL HOSPITAL
2019
 Hypertensive disorders of pregnancy (HDP)

Materials & Methods

Atherosis is observed

Background
Conclusion

in 20 – 40% of women
Comment

with preeclampsia (PE).

Results

• 2 – 10% of pregnancies
in the Western world
• Increased risk of HYPOTHESIS:
morbidity and mortality
for both mother and An atherogenic lipid profile
child • Increases the risk of endothelial
• More susceptible for damage in the arterial vessel wall.
later-life cardiovascular • Increases risk of HDP and a higher
disease (CVD) blood pressure during and years
after pregnancy.

Objective: To assess the associations between maternal lipid profile in early

pregnancy, HDP, blood pressure throughout pregnancy, and blood pressure and
sustained hypertension 6 and 9 years after pregnancy.
 Design and study population

8976 women enrolled during pregnancy

Materials & Methods

Background
Conclusion

• A twin pregnancy
Comment

Results

• Gestational diabetes
• Diabetes mellitus
Exclusion
criteria • Hypercholesterolemia
• Those using medication for the
regulation of glucose or
cholesterol

5690 women from Generation R Study, an ongoing

population-based prospective cohort study
 Maternal lipid levels in early pregnancy
• Nonfasting blood samples were obtained in early pregnancy to
determine the levels of total cholesterol, triglycerides, and
HDLc.

Materials & Methods

Background
Conclusion

Maternal anthropometrics
Comment

Results

• Prepregnancy body mass index (BMI) (kilograms per square

meter).
• Maternal weight and height were measured in early, mid-, and
late pregnancy and 6 and 9 years after pregnancy without
shoes and heavy clothing.

Blood pressure and HDP

• Systolic blood pressure (SBP) and diastolic blood pressure (DBP)
were measured in early pregnancy, mid pregnancy, late
pregnancy, and 6 and 9 years after pregnancy.
 Covariates

Materials & Methods

• Maternal age, ethnicity, educational level, and parity at intake

Background
• Gestational age at birth, child’s sex, and birthweight
Conclusion

Comment

Results

Statistical Analysis
• Comparing the characteristics of women included in this study
with women with inclusion in mid- or late pregnancy.
• IBM Statistical Package of Social Sciences version 24.0
forWindows (SPSS Inc, Chicago, IL).
• A value of P <.05 was considered statistically significant.
 Conclusion

Comment
Table 1. Baseline Characteristics (n = 5690)

Results

Materials & Methods

Background
 Conclusion

Comment
Table 1. Baseline Characteristics (n = 5690)

Results

Materials & Methods

Background
 Table 2. Maternal lipid profile in early pregnancy and maternal weight

Materials & Methods

Background
Conclusion

Comment

Results
 Table 3. Associations of maternal lipid profile in early pregnancy with gestational
hypertension and preeclampsia

Materials & Methods

Background
Conclusion

Comment

Results
 Table 3. Associations of maternal lipid profile in early pregnancy with gestational
hypertension and preeclampsia

Materials & Methods

Background
Conclusion

Comment

Results
 Figure 1. Association of maternal lipid profile with blood pressure

Materials & Methods

Background
Conclusion

Comment

Results
 Figure 1. Association of maternal lipid profile with blood pressure

Materials & Methods

Background
Conclusion

Comment

Results
 Table 4. Associations of maternal lipid profile in early pregnancy with sustained hypertension
years after pregnancy

Materials & Methods

Background
Conclusion

Comment

Results
 Higher levels of triglycerides and remnant
cholesterol in early pregnancy

associated
Higher blood pressure during pregnancy
Higher blood pressure and sustained

Materials & Methods

with
hypertension 6 and 9 years afterward.

Background
Conclusion

Comment

Results
Author’s hypothesis:

•Women with increased lipid levels in early pregnancy are

at risk of CVD later in life.
1

•Lipid level assessment in early pregnancy may be used.

2
 Current hypothesis of PE

Local
inflammation
and oxidative
Endothelial
stress
dysfunction

Materials & Methods

accompanied Symptoms of PE
related hypoxia
by acute
in the placenta

Background
atherosis of the
Conclusion

Comment
spiral arteries of

Results
the placenta
!

Women with PE had a significant increase of adipocyte

fatty acid-binding proteins (AFABP)  increased levels of
triglycerides.

In contrast,
No association of maternal lipid levels in early
pregnancy with blood pressure for women with GH
 In pregnancy, plasma HDL-c
concentrations start to rise at 10 weeks
of gestation, peaking at 20 weeks.

Materials & Methods

Background
Conclusion

Comment

Results
No difference were found in HDL-c
levels between normotensive women
and women with PE

BMI is associated with HDP and

increased SBP and DBP in pregnancy.
 Higher prepregnancy BMI leads to
altered lipid levels in early pregnancy

Materials & Methods

Background
Conclusion

Comment
Excessive weight gain during

Results
pregnancy is a potential confounder
in the association between lipid levels
and PE

Both the maternal lipid profile

(especially triglycerides) and BMI
independently influence SBP and DBP.
 Strength:
• This study is the first to assess non-HDL-c and
remnant cholesterol measures  new important risk
factors for CVD  may be used as a clinical tool to
predict a HDP and future CVD

Materials & Methods

Background
Limitations:
Conclusion

Comment
• Venous blood samples were obtained in a nonfasting

Results
state.
• Prepregnancy BMI was self-reported.
• Other obesity indices as waisthip ratio and waist
circumference.
• The observational nature of this study does not allow for
inference of causality and does not preclude the
existence of residual confounding.
• Blood samples were obtained in early pregnancy.
• Levels of total cholesterol, triglycerides, LDL-c, remnant
cholesterol, and non-HDL-c are higher in overweight
women.
• These results might not be generalizable to all women.
 1
Maternal lipid levels in early pregnancy are
associated with blood pressure throughout
pregnancy and years after pregnancy.

Materials & Methods

2

Background
Conclusion

Comment
Higher levels of triglycerides and remnant

Results
cholesterol in early pregnancy are associated
with an increased risk of PE and sustained
hypertension long term postpartum.

3
Maternal lipid levels in early pregnancy
increase the risk of PE and sustained
hypertension, therefore be used as an early
marker for later-life CVD.
Thank you