Is maternal lipid profile in early pregnancy associated with pregnancy complications and blood pressure in pregnancy and long term postpartum?
Is maternal lipid profile in early pregnancy associated with pregnancy complications and blood pressure in pregnancy and long term postpartum?
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DOI：
10.1016/j.ajog.2019.03.025
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发表时间：
2019-08-01
影响因子：
9.8
通讯作者：
Steegers, Eric A. P.
中科院分区：
文献类型：
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作者：
Adank, Maria C.;Benschop, Laura;Steegers, Eric A. P.
背景：致动脉粥样硬化脂质谱是动脉粥样硬化发生和进展的危险因素。这最终会导致心血管疾病。有妊娠期高血压病史的女性在以后的生活中患持续性高血压和心血管疾病的风险增加。目前尚不清楚妊娠期间血脂异常是否会导致这些风险。 目的：本研究的目的是确定妊娠早期母亲的血脂状况、妊娠高血压疾病以及妊娠期间和妊娠后数年的血压之间的关联。 研究设计：我们纳入了来自 R 世代研究（一项正在进行的基于人群的前瞻性出生队列）的 5690 名女性。 218 名女性 (3.8%) 患有妊娠期高血压，139 名女性 (2.4%) 患有先兆子痫。在妊娠早期（中位妊娠 13.4 周）测定母体血脂谱，包括总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、残余胆固醇和非高密度脂蛋白胆固醇。妊娠早期、中期、晚期以及妊娠后6年和9年测量收缩压和舒张压。结果：妊娠早期甘油三酯和残余胆固醇与先兆子痫呈正相关。妊娠早期母亲血脂水平与妊娠期高血压无关。总胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇，尤其是甘油三酯和残余胆固醇与妊娠期以及妊娠后6年和9年的血压呈正相关。甘油三酯和残余胆固醇与妊娠后 6 年和 9 年的持续高血压呈正相关。结论：妊娠早期的致动脉粥样化脂质谱反映了富含甘油三酯的脂蛋白代谢受损，与先兆子痫和整个妊娠期的血压独立相关，但也与产后长期持续高血压相关。怀孕早期的脂质水平可能有助于识别未来有患高血压风险的女性，也可能有助于识别未来有患心血管疾病风险的女性。
BACKGROUND: An atherogenic lipid profile is a risk factor for the initiation and progression of atherosclerosis. This ultimately leads to cardiovascular disease. Women with a history of hypertensive disorders of pregnancy are at increased risk of sustained hypertension and cardiovascular disease later in life. Currently it is unclear whether dyslipidemia during pregnancy contributes to these risks.OBJECTIVE: The objective of the study was to determine the associations between early pregnancy maternal lipid profile, hypertensive disorders of pregnancy, and blood pressure during and years after pregnancy.STUDY DESIGN: We included 5690 women from the Generation R Study, an ongoing population-based prospective birth cohort. Two hundred eighteen women (3.8%) developed gestational hypertension and 139 (2.4%) preeclampsia. A maternal lipid profile consisting of total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, remnant cholesterol, and non-high-density lipoprotein cholesterol was determined in early pregnancy (median, 13.4 weeks of gestation). Systolic and diastolic blood pressures were measured in early, mid-, and late pregnancy and 6 and 9 years after pregnancy.RESULTS: Triglycerides and remnant cholesterol in early pregnancy were positively associated with preeclampsia. Maternal lipid levels in early pregnancy were not associated with gestational hypertension. Total cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and especially triglycerides and remnant cholesterol were positively associated with blood pressure in pregnancy and 6 and 9 years after pregnancy. Triglycerides and remnant cholesterol are positively associated with sustained hypertension 6 and 9 years after pregnancy.CONCLUSION: An atherogenic lipid profile in early pregnancy reflecting impaired triglyceride-rich lipoprotein metabolism is independently associated with preeclampsia and blood pressure throughout pregnancy but also with sustained hypertension long term postpartum. Lipid levels in early pregnancy may help to identify women at risk for future hypertension and perhaps also women at risk for future cardiovascular disease.