The aim of the present pilot study was to determine associations between maternal Apolipoprotein E (ApoE) genotype, lipid levels during pregnancy, fetal growth, and placental pathology.

In this case-control study, serum samples from pregnant women without hypertension who delivered small-for-gestational age (SGA) infants (n = 50) were matched on gestational age at sample collection with non-SGA infants (n = 100). ApoE allele distributions and lipid levels were compared between cases and controls and among placental pathological findings.

No differences in ApoE genotypes were noted between groups. High density lipoprotein (HDL) cholesterol levels were higher in ε2 carriers versus ε3/ε3 and ε4 carriers (78.1 vs. 67.7 vs. 64.0 mg/dL, p < 0.01 and p < 0.001, respectively), and in SGA pregnancies (73.2 vs 65.1 mg/dL, p = 0.003).

Findings suggest increased HDL in pregnancy may be associated with the ε2 allele and decreased fetal growth. These findings provide a useful starting point for further research and should be explored in larger population-based studies.

This study investigated the relationship between dyslipidemia prior to conception and the risk of preeclampsia (PE) in women pregnant by in vitro fertilization and embryo transfer (IVF-ET). The retrospective cohort study consisted of 2994 women who conceived by IVF-ET and delivered live neonates. The study population was divided into two components: a training set for the prediction model development (2288 women) and a test set for validation (706 women). Multivariable logistic regression was used for the development and validation of predictive model for the risk of PE. Among the 2288 women in the training set, 266 women (11.6%) developed PE. Multiple logistic regression analysis identified independent predictors for PE: triglyceride (TG) [adjusted odds ratio (aOR) 1.284; 95% confidence interval (CI) 1.113-1.489, P < 0.001]; pre-pregnancy BMI; pre- chronic hypertension; twin pregnancy; embryo transfer protocol. These independent predictors for PE were used to form a risk prediction model, and the area under the receiver-operator characteristic (ROC) curve (AUC) in the training and the test set was 0.77 (95% CI 0.73-0.80)and 0.71 AUC (95% CI 0.65-0.77), respectively. In conclusion, higher TG levels before pregnancy were independently associated with the risk for PE in women pregnant by IVF-ET.

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder characterized by maternal pruritus and elevated serum bile acids. Twin pregnancies, as a type of high-risk pregnancy, present additional complexities when complicated by ICP compared to singleton pregnancies. Our study aims to investigate the relationship between bile acid levels in intrahepatic cholestasis of pregnancy and adverse pregnancy outcomes such as preterm birth and stillbirth in twin pregnancies.

This retrospective single-center cohort study was conducted at the Second Hospital of Sichuan University from January 2014 to July 2022, focusing on twin pregnancies complicated by ICP. Patients were grouped based on peak levels of total bile acids during pregnancy. Differences among these groups in gestational weeks at delivery, preterm birth, fetal growth restriction, fetal distress, stillbirth, premature rupture of membranes, meconium-stained amniotic fluid, and newborn birth weight were observed as pregnancy outcome indicators.

In 1156 twin pregnancies complicated by ICP, were 430 cases classified as mild, 392 as moderate-low, 292 as moderate-high, and 42 as severe. Regarding pregnancy outcomes, significant differences were observed among the four groups of pregnant women in terms of gestational weeks at delivery (P < 0.001), rate of preterm birth (P < 0.001), newborn birth weight (P < 0.001), incidence of meconium-stained amniotic fluid (P < 0.001), and proportion of low birth weight infants (P < 0.001).

The study results indicate that the severity of intrahepatic cholestasis of pregnancy (ICP) is associated with adverse pregnancy outcomes such as preterm birth, newborn birth weight, and meconium-stained amniotic fluid contamination. Additionally, among different bile acid level groups, gestational weeks at delivery showed varying trends in stillbirth occurrence.

Severe preeclampsia (PE) is associated with adverse pregnancy outcomes. The present study aims to identify risk factors contributing to these outcomes in women diagnosed with severe PE. This retrospective observational study included pregnant women diagnosed with severe PE from January 2023 to December 2023. Adverse pregnancy outcomes defined as hypertension accompanied by any of the following: elevated liver enzymes, low platelet count, disseminated intravascular coagulation, placental abruption, pulmonary edema, cerebral hemorrhage, seizures, or death-and adverse fetal outcomes-defined as iatrogenic delivery, small-for-gestational-age, abnormal umbilical hemodynamics, or death. A total of 351 patients with severe PE were included in the analysis (adverse pregnancy outcome group, n = 184; control group, n = 167). Multivariate logistic regression analysis identified gestational age at delivery (odds ratio [OR] = 0.924; 95% confidence interval [CI]: 0.896-0.953, P < .001), twin pregnancy (OR = 5.586; 95% CI: 2.774-11.250, P < .001), reduced placental growth factor (PlGF) levels (OR = 0.999; 95% CI: 0.998-1.000, P = .011), and elevated total cholesterol levels (OR = 1.562; 95% CI: 1.320-1.849, P < .001 were independent risk factors for adverse pregnancy outcomes. The combination of gestational age, PlGF, and total cholesterol demonstrated high predictive accuracy, with an area under the curve of 0.867 (95% CI: 0.826-0.908), 79.35% sensitivity, and 90.42% specificity. This study suggests that lower gestational age, twin pregnancy, reduced PlGF, and elevated total cholesterol may be significant risk factors for adverse pregnancy outcomes in women diagnosed with severe PE.

This study aimed to investigate the effect of mid-pregnancy lipid levels on adverse outcomes in women with gestational diabetes mellitus (GDM) under adequate glycemic control. Whether this effect is independent of factors such as blood glucose was also analyzed.

We retrospectively analyzed 1,001 women with normal glucose tolerance (NGT) and 1,078 women with GDM under adequate glycemic control from 2015 to 2024. Logistic regression analysis was used to explore the relationship between blood lipids and adverse outcomes. Those with GDM were further classified according to their pre-pregnancy body mass index (BMI), gestational weight gain, glycosylated hemoglobin A1c (HbA1c), and fasting blood glucose (FBG). An interaction model between triglyceride (TG) and pre-pregnancy BMI, gestational weight gain, HbA1c, and FBG on adverse outcomes was constructed.

In GDM, high levels of TG were independent risk factors for preeclampsia (OR = 1.51, 95%CI = 1.18-1.93), preterm birth (OR = 1.68, 95%CI = 1.30-2.18), macrosomia (OR = 1.48, 95%CI = 1.14-1.92), postpartum hemorrhage (OR = 1.33, 95%CI = 1.10-1.61), and intrauterine fetal distress (OR = 1.68, 95%CI = 1.13-2.51). Furthermore, TG had a greater impact on GDM women than on NGT women. In addition, in GDM, high levels of TG were independent risk factors for the above adverse outcomes in the subgroups of pre-pregnancy BMI, gestational weight gain, HbA1c, and FBG (interaction p > 0.05).

High levels of TG promoted the occurrence of preeclampsia, preterm birth, macrosomia, postpartum hemorrhage, and intrauterine fetal distress in women with GDM. Furthermore, TG had a greater effect on adverse outcomes in GDM than in NGT women.

Tenofovir alafenamide (TAF)-based antiretroviral therapy (ART) regimens have been associated with adverse changes in lipid and glucose profiles compared with tenofovir disoproxil fumarate (TDF)-based ART, but data in pregnancy are limited. We evaluated metabolic markers in pregnant women with human immunodeficiency virus (HIV) after starting TAF- versus TDF-based ART.

We analyzed data within the IMPAACT 2010/VESTED trial, which demonstrated better pregnancy outcomes in pregnant women randomized to initiate TAF/Emtricitabine/Dolutegravir (TAF/FTC + DTG; n = 217) or TDF/FTC + DTG (n = 215). We measured non-fasting plasma concentrations of glucose, total-cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), lipoprotein (a), and triglycerides from samples collected 8 weeks after enrollment. We employed linear regression models to estimate by-arm mean differences.

In total, 219 participants enrolled in the DTG arms in Zimbabwe and Uganda: 109 in the TAF/FTC + DTG and 110 in the TDF/FTC + DTG arms. At study entry, mean gestational age was 22.6 weeks, median HIV-1 RNA was 711 copies/mL, and mean age was 25.8 years. By 8 weeks, mean total cholesterol was 12 mg/dL higher in women randomized to TAF/ FTC + DTG versus TDF/FTC + DTG (95% confidence interval [CI]: 3.8, 21.1). Pregnant women in the TAF/FTC + DTG arm had higher mean LDL-C (7.1 mg/dL, 95% CI: .2, 14.0), triglycerides (12.3 mg/dL, 95% CI: 1.8, 22.7), lipoprotein (a) (7.3 mg/dL, 95% CI: 1.1, 13.6), and lower mean HDL-C (2.8 mg/dL, 95% CI: .1, 5.6) compared to the TDF/FTC + DTG arm.

Pregnant women randomized to start TAF/FTC + DTG had higher lipids than those randomized to TDF/FTC + DTG within 8 weeks of ART initiation. However, lipid levels were within normal reference ranges.

This investigation assesses the perinatal risks associated with different clinical subtypes of intrahepatic cholestasis of pregnancy (ICP) based on clinical symptomatology, with the goal of informing optimal delivery timing for each specific ICP subtype.

The retrospective study encompassed 2,057 singleton pregnancies with ICP, categorized into the single-symptomatic (ICP-S) and the multisymptomatic (ICP-M) groups. The ICP-M group was further subdivided based on symptom combinations: elevated TBA with elevated transaminases (ICP-MT), elevated TBA with pruritus (ICP-MP), and combined elevations with pruritus (ICP-MB). The investigation included an assessment of baseline characteristics, a comparison of perinatal outcomes between the ICP-S and ICP-M groups, an evaluation of the impact of ursodeoxycholic acid and second-line treatments, and the analysis of severe adverse neonatal outcomes by clinical classification and gestational age through the logistic regression and restricted cubic spline methods.

Baseline characteristics suggested in vitro fertilization (IVF) and nullipara as more prevalent in the ICP-M, which also had an earlier diagnosis of ICP than in the ICP-S. In addition, the ICP-M exhibited higher liver function and blood glucose levels. The ICP-M was significantly associated with increased risks of gestational diabetes mellitus (GDM) (OR 1.57), preterm birth (OR 1.92), low-birth-weight infant (OR 1.81), and neonatal intensive care unit (NICU) admissions (OR 1.48) than the ICP-S. Among the ICP-M subgroups, the ICP-Mp exhibited the highest risk of adverse outcomes. Ursodeoxycholic acid (UDCA) treatment was found to be beneficial in reducing the risk of preterm birth, particularly in the ICP-M. The study also highlighted that late preterm or post-term delivery in the ICP-M patients exacerbates NICU risk.

Women with ICP-M experience elevated perinatal risks, including a higher risk of coexisting GDM, as well as increased risks of preterm birth and NICU admissions. Personalized clinical management, optimizing delivery timing based on clinical subtypes, and providing UDCA to improve neonatal outcomes during pregnancy are important measures worthy of attention.

Intrahepatic cholestasis of pregnancy (ICP) can be a source of significant distress for both pregnant women and the fetus, impairing the quality of life and well-being of pregnant women, leading to psychological disorders among pregnant women with severe or recurrent ICP, and causing life-threatening complications among fetuses. Regrettably, our current understanding of ICP globally is limited, lacking a comprehensive estimation of its incidence. Therefore, in this systematic review and meta-analysis, we aimed to investigate the global and regional incidence of ICP and identify factors that account for its variety across studies.

A comprehensive search strategy was implemented across PubMed, Scopus, and Web of Science databases. To stabilize the variance, the Freeman-Tukey double arcsine transformation was employed. Subgroup analyses were conducted based on continent, publication type, study design and timing, regional classifications, developmental status, and World Bank income grouping. A multivariate meta-regression analysis was performed to estimate the effects of the continuous moderators on the effect size.

A total of 42,972,872 pregnant women were analyzed from 302 studies. The overall pooled incidence [95% confidence interval] of ICP was 2.9% [2.5, 3.3]. Studies with larger sample sizes tended to provide significantly lower estimates of ICP incidence: 1.6% [1.3, 2] vs 4.7% [3.9, 5.5]. Asia had the highest incidence of ICP among the continents, whereas Oceania had the lowest. Countries that were classified as developed and with higher income had a lower incidence of ICP than those classified as developing and low and middle income.

The findings of this study will provide valuable insights into the current knowledge regarding the association of the quality of public health and socioeconomic variations with the incidence of ICP on a global scale.

Background/Objectives: Glucose and lipid metabolism during pregnancy are crucial for perinatal outcomes. Recently, chrono-nutritional factors have been partially identified as influencing pregnancy metabolism. This study aimed to investigate overnight fasting duration and meal frequency during pregnancy and to clarify their associations with glucose and lipid metabolism. Methods: This cross-sectional study was conducted at a university hospital in Tokyo, Japan, between February 2020 and June 2021. A self-administered questionnaire was used to evaluate overnight fasting duration and meal frequency in 144 pregnant women in their second trimester. Nutrient intake was assessed using the brief-type self-administered diet history questionnaire. Non-fasting blood samples were collected and analyzed for levels of total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and glycated albumin. Results: The mean ± standard deviation of overnight fasting duration was 12.1 ± 1.5 h, meal frequency was 3.8 ± 0.9 times per day, and glycated albumin level was 13.3 ± 1.0%. Multivariate analysis revealed that a longer overnight fasting duration was significantly associated with lower glycated albumin levels (β = -0.167, p = 0.030). Conclusions: These findings suggest that, in addition to meal content and quantity, overnight fasting may be effective in appropriately managing glycated albumin levels during the second trimester of pregnancy.

Trimester-specific reference intervals (TSRIs) for maternal lipid profiles should be determined, and the impact of dyslipidemia on adverse pregnancy outcomes (APOs) should be estimated.

Data from 25,081 pregnant women in a large Southeast Chinese cohort were collected. Serial lipid profiling was performed throughout gestation, with measurements obtained during the first, second, and third trimesters, as well as within 24 h of delivery. The truncated maximum likelihood (TML) method, the Hoffman method, and inverse modelling were employed to establish TSRIs for lipids, with TML as the primary method. The associations of dyslipidemia with APOs were investigated by logistic regressions within the setting of TSRIs for various lipids.

The TSRIs established by the TML method were as follows: 3.36-6.06, 4.19-7.89, 4.60-8.97, and 4.41-8.79 mmol/L for total cholesterol; 0.66-2.32, 1.11-3.75, 1.49-4.77, and 1.61-6.14 mmol/L for triglycerides; 1.42-3.61, 1.94-5.13, 1.95-5.39, and 1.86-5.50 mmol/L for low-density lipoprotein cholesterol; 1.11-2.31, 1.30-2.75, 1.24-2.59, and 1.20-2.65 mmol/L for high-density lipoprotein cholesterol; 1.89-4.20, 2.59-5.85, 2.87-6.17, and 2.88-6.78 mmol/L for non-high-density lipoprotein cholesterol; 1.04-1.96, 1.25-2.41, 1.23-2.46, and 1.25-2.47 g/L for apolipoprotein A1; 0.43-0.82, 0.63-1.17, 0.65-1.55, and 0.79-1.77 g/L for apolipoprotein B; and 0.27-0.79, 0.35-0.94, 0.39-1.11, and 0.40-1.15 for the apolipoprotein B and apolipoprotein A1 ratio from the first trimester to the delivery period, respectively. The results of the Hoffman and inverse modelling methods closely aligned with those of the TML method. In pregnant women, lipid levels that deviate above or below the established TSRIs are significantly associated with the occurrence of APOs.

TSRIs are recommended for the identification and management of dyslipidemia during pregnancy. Inappropriate maternal blood lipid levels are associated with an increased risk of APOs.

This study aimed to develop and evaluate a nomogram for predicting preterm birth in patients with intrahepatic cholestasis of pregnancy (ICP), with a view to assisting clinical management and intervention.

This retrospective observational study included 257 pregnant women with ICP from Sichuan Provincial People's Hospital between January 1, 2022 and July 30, 2024. The routine clinical and laboratory information of these patients were also collected. We used the least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression analysis to investigate the association between clinical and laboratory data and preterm birth in ICP patients. A nomogram was developed to predict the likelihood of preterm birth in ICP patients. The prediction accuracy of the model was evaluated by consistency index (C-index), receiver operating characteristic (ROC) curve, area under the curve (AUC), and calibration curve. Decision curve analysis (DCA) was used to evaluate its applicability in clinical practice.

Among the 257 ICP patients, 56 (21.79%) were diagnosed with preterm birth. Cases were randomly divided into a training set (154 cases) and a test set (103 cases). A nomogram was developed to predict preterm birth in ICP patients based on height, twin pregnancy (TP), gestational age at diagnosis (GA at diagnosis), and total bile acid level (TBA) at diagnosis. The calibration curve of the training set was close to the diagonal (C-index = 0.864), and the calibration curve of the test set was also close to the diagonal (C-index = 0.835). These results indicate that the model has a good consistency. The AUC of the training group and the test group were 0.864 and 0.836, respectively, indicating the good accuracy of the model. The DCA reveals that this nomogram could be applied to clinical practice.

The combination of TBA level, TP, height and GA at diagnosis is an effective model for identifying preterm birth in ICP patients. These results will help guide the clinical management and treatment of patients with ICP, thereby reducing maternal and infant safety issues caused by preterm birth.

A wealth of evidence indicates that dyslipidemia is associated with endothelial dysfunction, oxidative stress, and inflammation, each of which can impair reproductive function and lead to infertility. The Atherogenic Index of Plasma (AIP) is an innovative lipid biomarker that combines the triglyceride to high-density lipoprotein cholesterol (HDL-C) ratio, providing a more in-depth evaluation of lipid metabolism. This biomarker synthesizes discrete lipid disruptions into a single value, surpassing isolated lipid indicators' diagnostic value. The primary goal of our study was to explore the link between AIP and the incidence of infertility.

Data from the National Health and Nutrition Examination Survey (NHANES) spanning 2013-2018 were subjected to cross-sectional examination. The AIP is determined through the logarithmic transformation (base 10) of the triglyceride-to-HDL-C ratio. To uncover the connection between AIP and infertility, a suite of analytical techniques was employed, encompassing weighted multiple logistic regression, stratified analyses, spline curve modeling, and determination of cutoff values.

Among the 1,191 participants, with a weighted mean age of 31.89 years, 12.09% were diagnosed as infertile. The multivariate-adjusted odds ratios for infertility occurrence across the AIP quartiles were 1.00 (reference), 1.96 (95% CI: 1.10-3.49), 2.62 (95% CI: 1.48-4.63), and 2.38 (95% CI: 1.31-4.32), respectively. Subgroup examinations suggest that the association between AIP and infertility remains robust and is not substantially altered by factors including age, marital status, economic status, tobacco use, alcohol intake, and body mass index. Curve fitting and threshold analyses have indicated a positive nonlinear relationship between AIP and infertility, as well as a relatively stable incidence of infertility within the AIP range from -0.21 to 0.22.

Incorporating an assessment of AIP into the clinical evaluation could potentially refine the accuracy of risk estimation for infertility patients.

To establish the reference interval for the serum lipid index in pregnant women and to explore the relationship between lipid metabolism levels and pregnancy outcomes.

Data were derived from 446 pregnancy women and 317 healthy non-pregnant women. Serum levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), lipoprotein (a) [Lp(a)], and hypersensitive C-reactive protein (hs-CRP) were measured in both groups. The mean and standard deviation of each index were calculated to establish the reference range of normal serum lipid levels in pregnant women in mid-to-late pregnancy. The associations between serum lipid levels and perinatal outcomes were assessed statistically.

There were no significant differences in age, pregnancy, or parity between the adverse outcome and normal delivery groups, but the caesarean section rate was significantly higher in the adverse outcome group. The levels of hs-CRP, TG, TC, HDL-C, LDL-C, and ApoA1 were significantly higher in the adverse outcome group. Elevated hs-CRP, TG, and HDL-C levels were risk factors for adverse pregnancy outcomes. According to the receiver operating characteristic curve, the optimal threshold of the combined diagnosis of these three indicators to predict adverse pregnancy outcomes was 0.534, and the area under the curve was 0.822.

The establishment of lipid reference intervals in the second and third trimesters of pregnancy can effectively evaluate lipid metabolism in pregnant women, and the measurement of lipid metabolism in pregnant women is helpful in predicting adverse pregnancy outcomes.

Maternal glucose and lipid levels are known to influence fetal growth. However, data on how maternal lipid profiles affect birth size in women with gestational diabetes (GDM) compared with those without GDM are scarce.

This retrospective study included 10,490 women with singleton pregnancies (2351 with GDM and 8139 without GDM) between December 2016 and July 2022. Maternal serum levels of total cholesterol (TC), triglycerides (TGs), low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol were measured at 28-42 weeks of gestation. Maternal glucose levels were determined using the 2-h oral glucose tolerance test. The neonatal birth weight was obtained at delivery and standardized as the birth weight z score according to the INTERGROWTH-21st standards.

Compared with women without GDM, those with GDM presented increased mean TG levels and decreased levels of TC, HDL cholesterol, and LDL cholesterol. TG levels were positively associated with birth weight in both the GDM and non-GDM groups, whereas TC, HDL cholesterol, and LDL cholesterol levels were mildly negatively correlated with birth weight. In the GDM group, an increase of 1 mmol/L in maternal TGs correlated with a 28.4 g increase in birth weight (95% CI: 17.8 to 39.1), whereas increases of 1 mmol/L in TC (-19.2 g; 95% CI: -31.9 to -6.5), HDL cholesterol (-120.7 g; 95% CI: -164.8 to -76.6), and LDL cholesterol (-22.2 g; 95% CI: -40.4 to -4) were associated with a decrease in birth weight. Compared with women with GDM with TG levels ≤ the 10th percentile, those with TG levels ≥ the 90th percentile had increased risks of large-for-gestational-age offspring (adjusted OR: 3.09; 95% CI: 1.51-6.30) and macrosomia (adjusted OR: 4.04; 95% CI: 1.37-11.93); this risk was stronger than that in women without GDM.

This study provides evidence of a significant association between maternal lipid levels during late pregnancy and offspring birth size. However, the observational nature of the study limits the ability to establish causal relationships regarding the direct impact of lipid levels on birth size. Additionally, the influence of maternal lipid profiles is disproportionately greater in women with GDM than in women without GDM.

While guidelines recommend bedtime snacks for women with gestational diabetes mellitus (GDM), there is insufficient evidence championed those recommendation.

To evaluate if bedtime snacking is effective in preventing high fasting blood glucose incidence among women with GDM.

An open-label, parallel-group, randomized controlled trial was conducted from December 2023 to July 2024 at Ma'anshan Maternal and Child Health Care Center, Anhui, China.

A total of 62 GDM cases at the nutrition clinics were enrolled, and were randomly and equally allocated to groups of bedtime snacks (25 g nuts, intervention group) and no bedtime snacks (control group). The intervention was lasted for 8 weeks, during which fasting blood glucose was measured 3 times per week, 1-hour postprandial glucose and 2-hour postprandial glucose 2 times per week with a home glucometer. In the late pregnancy (approximately at 34 weeks), the glycated haemoglobin, high-density lipoprotein, low-density lipoprotein, triglycerides, total cholesterol were measured in the laboratory and birth outcomes information (birth weight, gestational weeks at delivery, delivery mode) were collected.

The primary outcomes were the level of fasting blood glucose and the hyper-fasting blood glucose incidence during 8-week duration. The secondary outcomes were the level of the glycated haemoglobin, high-density lipoprotein, low-density lipoprotein, triglycerides and total cholesterol in the late pregnancy. Generalized estimating equations and analysis of covariates were conducted for the analysis of the primary outcomes. The multivariate linear regression was conducted for the analysis of the secondary outcomes. Post-hoc analysis was also conducted for the indicators of 1-hour postprandial glucose, 2-hour postprandial glucose and perinatal outcomes applying generalized estimating equations, analysis of covariates, the multivariate linear regression and logistics regression.

After adjusting for maternal age, pre-pregnancy body mass index, mid-pregnancy glucose, mid-pregnancy blood lipids and diet in late pregnancy, neither the average fasting blood glucose (control group: 4.90 mmol l-1, intervention group: 4.96 mmol l-1) (β = 0.05, [95%CI-0.22 to 0.31], P = 0.720) nor hyper-fasting blood glucose incidence (control group: 0.19, intervention group:0.26) (β = 0.07, [95%CI-0.07 to 0.20], P = 0.335) were significant different between the two groups. And we found low-density lipoprotein level were higher in the intervention group (3.21 mmol l-1) compared to the control group (2.52 mmol l-1) (β = 0.70, [95%CI0.07 to 1.34], P = 0.031). Additionally, post-hoc analysis showed that the incidence of elevated 1-hour postprandial glucose was significantly higher in the intervention group (0.42) than in the control group (0.28) (β = 0.14, [95%CI0.01 to 0.27], P = 0.036). No difference was found regarding any perinatal outcomes between the two groups.

Bedtime snack did not reduce the risk of morning hyperglycaemia and adverse perinatal outcomes in women with gestational diabetes mellitus, but exacerbated lipid markers and the 1-hour postprandial glucose profile. Our study did not support clinicians and relevant guidelines to recommend bedtime snacking as a form of glycaemic control in women with GDM. Clinical trial identification number: ChiCTR2300078399. URL of the registration site: https://www.chictr.org.cn/bin/project/edit?pid=210400 .

Dyslipidemia is linked to pregnancy complications, but its causal role remains uncertain. This two-sample Mendelian Randomization (MR) study investigated the causal relationship between lipid traits and pregnancy complications and evaluated the impact of lipid-modifying drug targets.

Genetic instruments for lipid traits and targets for lipid-modifying drugs were obtained from the Global Lipids Genetics Consortium. Three pregnancy complications' summary statistics came from the FinnGen R9 database. Significant drug targets underwent further analysis using Expression Quantitative Trait Loci data, and mediation analysis identified potential mediators.

Increased high-density lipoprotein cholesterol (HDL-C) reduced the incidence of preeclampsia (OR: 0.755, 95% CI: 0.639-0.891, p=0.001, FDR=0.012) and gestational diabetes mellitus (GDM) (OR: 0.835, 95% CI: 0.741-0.942, p=0.003, FDR=0.018). Genetic proxies for cholesteryl ester transfer protein (CETP) inhibition correlated with a decreased risk of preeclampsia (OR: 0.863, 95% CI: 0.786-0.947, p=0.002, FDR=0.027), while genetic inhibition of HMG-CoA reductase (HMGCR) increased preeclampsia risk (OR: 1.700, 95% CI: 1.189-2.431, p=0.004, FDR=0.036). Genetically mimicking the enhancement of lipoprotein lipase (LPL) related to a reduced risk of GDM (OR: 0.681, 95% CI: 0.560-0.829, p=1.29×10-4, FDR=0.004). Higher LPL expression in subcutaneous adipose tissue also reduced GDM risk (OR: 0.642, 95% CI: 0.454-0.909, p=0.013). Waist circumference (4.2%) and waist-to-hip ratio adjusted by BMI (5.7%) partially mediated LPL's effect on GDM risk.

Elevated HDL-C levels help prevent preeclampsia and GDM. CETP and LPL could be therapeutic targets for preeclampsia and GDM, respectively. However, caution is advised with HMGCR-targeting drugs, as they may increase the preeclampsia risk.

Overweight and obesity (OWO) are linked to dyslipidemia and low-grade chronic inflammation, which is fueled by lipotoxicity and oxidative stress. In the context of pregnancy, maternal OWO has long been known to negatively impact on pregnancy outcomes and maternal health, as well as to imprint a higher risk for diseases in offspring later in life. Emerging research suggests that individual lipid metabolites, which collectively form the lipidome, may play a causal role in the pathogenesis of OWO-related diseases. This can be applied to the onset of pregnancy complications such as gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP), which in fact occur more frequently in women affected by OWO. In this review, we summarize current knowledge on maternal lipid metabolites in pregnancy and highlight associations between the maternal lipidome and the risk to develop GDM, HDP and childhood OWO. Emerging data underpin that dysregulations in maternal triglyceride, phospholipid and polyunsaturated fatty acid (PUFA) metabolism may play a role in modulating the risk for adverse pregnancy outcomes and childhood OWO, but it is yet premature to convert currently available insights into clinical guidelines. Well-designed large-scale lipidomic studies, combined with translational approaches including animal models of obesity, will likely facilitate the recognition of underling pathways of OWO-related pregnancy complications and child's health outcomes, based on which clinical guidelines and recommendations can be updated.

There is no evidence to suggest that an association exists between the remnant cholesterol (RC) to high-density lipoprotein cholesterol (HDL-C) ratio and gestational diabetes mellitus (GDM). In this study, the RC/HDL-C ratio during the first trimester was examined as a potential indicator of the onset of GDM during the second trimester.

This was a secondary analysis of data from a Korea-based prospective cohort study. The study involved 582 women within 14 weeks of pregnancy who were examined between November 2014 and July 2016 at two Korean hospitals. RC was calculated as total cholesterol (TC) minus the sum of low-density lipoprotein cholesterol (LDL-C) and HDL-C. The RC/HDL-C ratio was determined by dividing the RC content by the HDL-C content. The RC/HDL-C ratio and GDM occurrence were investigated utilizing a binary logistic regression model, various sensitivity analyses, and subgroup analyses. Additionally, the RC/HDL-C ratio was evaluated using receiver operating characteristic (ROC) analysis.

The average age of the pregnant women was 32.07 ± 3.78 years, and the RC/HDL-C ratio had a median value of 0.39. The prevalence of GDM was 6.01%. There was a positive association between the RC/HDL-C ratio and the incidence of GDM after adjusting for potential confounding variables (odds ratio: 21.78, 95% confidence interval [CI]: 3.55-133.73, P < 0.001). Furthermore, this association was validated by subgroup and sensitivity analyses. The results indicated that the RC/HDL-C ratio was a robust predictor of GDM, with an area under the ROC curve of 0.795 (95% CI: 0.723-0.868). The optimal threshold value was 0.45, with a sensitivity of 71.4% and a specificity of 75.3%. Compared with traditional lipid markers, including LDL-C, HDL-C, triglycerides, TC, and the emerging marker RC, the RC/HDL-C exhibited higher diagnostic efficacy.

There is an increased risk of GDM associated with higher levels of the RC/HDL-C ratio between 12 and 14 weeks of gestation, independent of traditional risk factors. The RC/HDL-C ratio is more effective in diagnosing GDM than traditional lipid markers.

Maternal overnutrition correlates with detrimental outcomes in offspring. However, the specific effects of gestational exposure to a high-fat diet (HFD) on fetal development remain unclear. This study aimed to elucidate the developmental phenotypes of neonatal organs and cardiomyocytes of mice exposed to gestational HFD, revealing growth retardation and a notable reduction in cardiomyocyte cell cycle activity. In this study, an HFD model was used to investigate the effects of maternal HFD on offspring development. Defective development was observed in the offspring, and severe restriction of cell proliferation was noted in the neonatal organs as a result of maternal HFD. Based on this evidence, we detected a reduction in cardiomyocyte proliferation in offspring exposed to maternal HFD. Moreover, RNA sequencing analysis revealed that HFD diminished fatty acid metabolism, enhanced the inflammatory response, and upregulated the transcription of genes involved in Tp53-regulated cell cycle arrest in postnatal day 0 (P0) cardiomyocytes. Furthermore, our results showed that the effects of the maternal diet during gestation are profound and normal lactation and feeding after delivery cannot help adult offspring recover from defective heart development. These findings highlight the diverse pathways affected by maternal HFD, particularly implicating a potential TP53-dependent mechanism contributing to cardiac defects in offspring.

Background: Maternal dyslipidemia during pregnancy may influence fetal cardiac development and function, potentially predisposing offspring to cardiovascular diseases later in life. This study aims to evaluate the relationship between maternal lipid profiles and fetal cardiac function at mid-gestation, utilizing detailed echocardiographic assessments. Methods: In this prospective cohort study conducted at the Obstetrics and Gynecology Clinic of the Timișoara Municipal Emergency Hospital, 19 pregnant women aged 27-40 years were recruited and divided into two groups based on their triglyceride levels: Group A (triglycerides ≤ 150 mg/dL, n = 48) and Group B (triglycerides > 150 mg/dL, n = 28). Maternal demographic data and lipid profiles were recorded. Fetal echocardiographic measurements, including global longitudinal strain and ventricular function parameters, were obtained between 20 and 24 weeks of gestation. Statistical analyses, including subgroup comparisons, correlations, and regression analyses, were performed. Results: Maternal BMI was significantly higher in Group B compared to Group A (31.94 ± 2.80 vs. 27.01 ± 2.40 kg/m2, p < 0.001). Group B showed higher mean triglyceride levels (163.43 ± 11.34 mg/dL) compared to Group A (131.42 ± 10.57 mg/dL, p < 0.001). Fetal echocardiographic measurements indicated reduced global longitudinal strain in fetuses of Group B mothers (LV strain: -19.86% ± 6.83% vs. -26.14% ± 5.92%, p = 0.017). Significant correlations were found between maternal triglyceride levels and fetal LV strain (r = 0.536, p = 0.019). Regression analysis identified maternal triglyceride levels and BMI as significant predictors of reduced fetal LV strain (β = 0.45, p = 0.021 and β = 0.39, p = 0.038, respectively). Conclusions: Elevated maternal triglyceride levels, LDL cholesterol, and BMI are associated with altered fetal cardiac function parameters at mid-gestation, suggesting that maternal lipid profiles may impact fetal cardiac development. These findings underscore the importance of monitoring lipid levels during pregnancy and suggest potential benefits of managing dyslipidemia to improve fetal cardiac outcomes. However, the study included only a small sample; therefore, the study needs to be continued with a larger group.

The association between serum triglyceride to high density lipoprotein cholesterol ratio (THR) in late pregnancy and adverse birth outcomes (ABO) remains controversial because of inconsistent results. The present study assessed the association between maternal serum THR and incidence of ABO [preterm birth (PTB), small and large for gestational age (SGA/LGA), low birth weight (LBW) and macrosomia] in a Chinese population.

A total of 11,553 consecutive participants from a real-world database with data on lipid profiles and birth outcomes were included. Logistic regression models were applied to assess the association between THR and incident ABO. Mediation analysis was performed to investigate the contribution of pregnancy complications [gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP) and pre-eclampsia (PE)] to this association.

Approximately 6.6% (762/11,553), 8.9% (1023/11,553), 15.5% (1792/11,553), 4.3% (494/11,553), and 7.4% (851/11,553) of individuals developed PTB, SGA, LGA, LBW and macrosomia, respectively. Significant trends across the quintiles of THR toward decreasing incidence of SGA and LBW and increasing incidence of LGA and macrosomia were observed. The multivariate-adjusted odds ratios (OR) in the top quintile of serum THR (> 3.16) versus the bottom quintile (< 1.44) were 0.52 for PTB, 0.48 for SGA, 0.64 for LBW, 2.80 for LGA and 3.80 for macrosomia, respectively. A 1-standard deviation (SD) increase in serum THR was associated with decreased risk of PTB [OR = 0.84, 95% confidence interval (CI): 0.76-0.93), SGA (OR = 0.71, 95% CI:0.65-0.78) and LBW (OR = 0.76, 95% CI:0.65-0.90) and increased risk of LGA (OR = 1.40, 95% CI:1.32-1.49) and macrosomia (OR = 1.49, 95% CI:1.38-1.62). In mediation analyses, PE mediated - 19.8%, -10.6% and - 24.6% of THR-associated PTB, SGA and LBW, respectively, GDM accounted for - 3.7%, 6.8% and 4.3% of THR-associated PTB, LGA and macrosomia, respectively, and ICP explained - 1.9% and - 2.1% of THR-associated PTB and LBW, respectively. In addition, incorporating THR to ABO predictive models significantly improved the area under the curve for SGA (0.743 vs. 0.753, P < 0.001), LGA (0.734 vs. 0.745, P < 0.001) and macrosomia (0.786 vs. 0.800, P < 0.001).

Real-world data showed an association between serum THR in late pregnancy and ABO risk, and this association may be partially mediated by prevalent pregnancy complications (PE/GDM/ICP), suggesting a potential role of THR in predicting ABO (SGA/LGA/macrosomia).

This study aimed to quantify adverse perinatal outcomes (APO), including small/large for gestational age (SGA/LGA) and preterm birth (PTB), in pregnant women with abnormal red cell distribution width (RDW) and explore the related mechanisms.

This study included 11,659 pregnant women who delivered in a specialized hospital. At the time of admission, the lipid profiles and whole blood cell counts were assessed, and APO was analyzed.

Women with high RDW (>18.5% [the 97.5th percentile]) in late pregnancy had a higher risk of LGA compared with those with low RDW (<12.3% [the 2.5th percentile]), whereas women with low RDW had a higher risk of SGA and PTB, compared with those with high RDW. A 1% increase in RDW was associated with an increased risk of LGA and a decreased risk of SGA and PTB. Consistent associations were observed in sensitivity analysis among pregnant women of non-advanced age, non-obesity, non-pregnancy complications, and non-PTB (for SGA/LGA only). Increased RDW was significantly associated with increased triglycerides and decreased high-density lipoprotein cholesterol (HDL-C). Triglycerides and HDL-C significantly mediated 10.63 and 15.8% of RDW-associated LGA, 9.51% and 9.40 of RDW-associated SGA, and 8.44 and -8.25% of RDW-associated PTB, respectively.

Abnormal RDW was associated with an increased risk of APO, and the RDW-associated APO risk could be partially mediated by triglycerides and HDL-C, suggesting that RDW may be a promising APO predictor.

To investigate the correlation between lipid levels during gestation and the incidence rate of gestational diabetes mellitus (GDM) and macrosomia.

Clinical records of 607 pregnant women with GDM (GDM group) who delivered in the Obstetrics Department of Fujian Maternal and Child Health Hospital from May to December 2018 and of 833 women with uncomplicated pregnancies (control group) were retrospectively analyzed. After delivery, the entire cohort was further grouped based on the weight of the neonates: women who delivered newborns with body mass <4 kg comprised the normal group (n = 1367), and pregnancies that resulted in delivery of neonates with body mass >4 kg were classified as the macrosomia group (n = 73). Fasting serum levels of triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and TG/HDL-C ratio were compared between the groups at the early (10-12 weeks), middle (24-28 weeks), and late (28 weeks-delivery) stages of pregnancy, and the correlation between the lipid indices and the rates of GDM and macrosomia were analyzed.

There was a gradual increase in TC, TG, LDL-C, and TG/HDL-C levels with increasing gestational weeks in pregnant women. TG and TG/HDL-C levels were markedly higher, while HDL-C was lower in women with GDM compared with women of the same gestational age with uncomplicated pregnancies (p < 0.05).

Lipid metabolism disorders exist in pregnant women with GDM at different gestational stages and are closely related to the higher incidence of macrosomia. TG, TG/HDL-C, and HDL-C in early and late pregnancy are independent risk factors for macrosomia in all trimesters, and TG/HDL-C ratio at different gestational stages has a good predictive value for macrosomia.

Maternal dyslipidemia is one of the consistent metabolic changes during pregnancy. There is a controversy as to whether maternal lipid disturbances in early pregnancy are associated with adverse maternal and perinatal outcome.

To determine the effects of maternal dyslipidemia on maternal and perinatal outcomes.

A prospective observational cohort study of eligible pregnant women attending antenatal clinic (ANC) at two tertiary hospitals in Southeast Nigeria. The attendees blood samples were collected for lipid profile analysis and those who met the criteria for dyslipidemia constituted the study (exposed) group, while those with normal lipid levels were the control (unexposed group). Both groups were followed up throughout pregnancy and in labor to determine the pregnancy and perinatal outcomes.

Compared with pregnant women with normal lipid profile, those with dyslipidemia were at higher risk of low birth weight (LBW) (RR: 9.40, CI 95%: 1.3-70.2, P = 0.005), intrauterine fetal death (IUFD) (RR: 5.98; 95% CI: 0.8-46.9; P = 0.04), still birth (RR: 6.84, CI 95%: 8.9-52.7, P = 0.03), and birth asphyxia (RR: 10.26, CI 95%:1.4-76.0, P = 0.003).

Maternal dyslipidemia is associated with some adverse perinatal outcomes such as LBW, IUFD, still birth, and birth asphyxia. These findings would guide in the care of pregnant women with dyslipidemia.

This study aimed to explore the potential causal association between PUFA and the risk of intrahepatic cholestasis of pregnancy (ICP) using Mendelian randomisation (MR) analysis. A two-sample MR analysis was conducted utilising large-scale European-based genome-wide association studies summary databases. The primary MR analysis was carried out using the inverse variance-weighted (IVW) method, complemented by other methods such as MR-egger, weighted-median and weighted mode. Sensitivity analysis was also performed to validate the robustness of the findings. Results indicated a 31 % reduced risk of ICP for every 1 standard deviation (sd) increase in n-3 fatty acids levels (OR = 0·69, 95 % CI: 0·54, 0·89, P = 0·004) and in the ratio of n-3 fatty acids to total fatty acids (OR = 0·69, 95 % CI: 0·53, 0·91, P = 0·008). Conversely, there was a 51 % increased risk of ICP for every 1 sd increase in the ratio of n-6 fatty acids to n-3 fatty acids (OR = 1·51, 95 % CI: 1·20, 1·91, P < 0·001) and a 138 % increased risk for every 1 sd increase in the ratio of linoleic fatty acids to total fatty acids (OR = 2·38, 95 % CI: 1·55, 3·66, P < 0·001). The findings suggest that n-3 fatty acids may have a protective effect against the risk of ICP, while n-6 fatty acids and linoleic fatty acids could be potential risk factors for ICP. The supplementation of n-3 fatty acids, as opposed to n-6 fatty acids, could be a promising strategy for the prevention and management of ICP.

A cluster of metabolic changes occur to provide energy for fetal growth and development during pregnancy. There is a burgeoning body of research highlighting the pivotal role of circadian rhythms in the pathogenesis of metabolic disorders and lipid homeostasis in mammals. Perturbations of the circadian system and lipid metabolism during gestation might be responsible for a variety of adverse reproductive outcomes comprising miscarriage, gestational diabetes mellitus, and preeclampsia. Growing studies have confirmed that resynchronizing circadian rhythms might alleviate metabolic disturbance. However, there is no clear evidence regarding the specific mechanisms by which the diurnal rhythm regulates lipid metabolism during pregnancy. In this review, we summarize previous knowledge on the strong interaction among the circadian clock, lipid metabolism, and pregnancy. Analyzing the circadian clock genes will improve our understanding of how circadian rhythms are implicated in complex lipid metabolic disorders during pregnancy. Exploring the potential of resynchronizing these circadian rhythms to disrupt abnormal lipid metabolism could also result in a breakthrough in reducing adverse pregnancy outcomes.

Maternal lipid metabolism has been implicated in elevating the risk of adverse pregnancy outcomes, which is a particularly significant concern in twin pregnancies. However, the precise relationship between early pregnancy dyslipidemia and the risk of preterm birth (PTB) in twin pregnancies remains unclear.

This retrospective cohort study included women with twin pregnancies between January 2018 and December 2023. Early pregnancy blood lipid profiles, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C), were examined. Dyslipidemia was diagnosed based on the diagnostic criteria outlined in the 2016 guidelines for the prevention and treatment of dyslipidemia in Chinese adults. PTB was defined as birth occurring before 37 weeks of pregnancy. Logistic regression models were used to evaluate the association of early pregnancy dyslipidemia with PTB in twin pregnancies.

A total of 613 women with twin pregnancies were included, and 141 women were complicated with dyslipidemia. The incidence of PTB < 37 weeks was significantly higher in the dyslipidemia group compared to the group without dyslipidemia (64.5% vs. 50.4%, P = 0.003). After adjusting for confounding factors, dyslipidemia was positively associated with PTB < 37 weeks (adjusted odds ratio: 1.71; 95% confidence interval: 1.13-2.58). However, these associations varied depending on the chorionicity and mode of conception of the twins. The positive associations between early pregnancy dyslipidemia and PTB < 37 weeks remained significant only in spontaneously conceived (SC) or dichorionic diamniotic (DCDA) twin pregnancies. No statistically significant associations were observed between dyslipidemia and the other secondary outcomes.

Early pregnancy dyslipidemia was positively associated with PTB < 37 weeks in twin pregnancies, and this association remained significant in SC or DCDA twin pregnancies. Comprehensive lipid profile assessment in the first trimester may be beneficial for patients' monitoring and implementing interventions to mitigate adverse pregnancy outcomes.

Preterm birth is the leading cause of neonatal mortality worldwide, and dyslipidemia is associated with preterm birth in observational studies. We use Mendelian randomization (MR) analyses to uncover the causal association between blood lipid levels and preterm birth.

We extracted uncorrelated (R2 < 0.001) single-nucleotide polymorphisms strongly associated (p < 5 × 10-8) with blood lipids from genome wide association studies of FinnGen database and UK Biobank participants. Inverse variance weighted method was the main MR analysis. Sensitivity analyses including genetic pleiotropy, heterogeneity, and directionality of causality were conducted.

The study included 115,082 participants with lipid measurements, 8,507 patients with preterm birth. Increasing apolipoprotein B (odds ratio (OR), 1.12[95 % CI, 1.02-1.23]; p = 0.019), low-density lipoprotein cholesterol (OR, 1.11[95 % CI, 1.00-1.22]; p = 0.040), non-high-density lipoprotein cholesterol (OR, 1.12[95 % CI, 1.01-1.24]; p = 0.026), remnant cholesterol (OR, 1.11[95 % CI, 1.00-1.23]; p = 0.047) and total free cholesterol (OR, 1.11[95 % CI, 1.01-1.23]; p = 0.037) were associated with increased risk of preterm delivery. Moreover, triglycerides in low-density lipoprotein were causally associated with the risk of PTB. Our sensitivity analysis yielded robust results, uncovering no evidence of horizontal pleiotropy or reverse causal relationships.

Our investigation unveils the adverse impact of dyslipidemia on preterm birth, with a particular emphasis on the detrimental effect of elevated low-density lipoprotein cholesterol.

Metabolic syndrome (MetS) is a cluster of metabolic risk factors that predict cardiovascular disease. Previous studies suggested that MetS impaired clinical outcomes in women with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF).

To evaluate the effects of MetS on IVF/intracytoplasmic sperm injection (ICSI) outcomes in women without PCOS.

This retrospective study collected 8539 eligible women without PCOS who came for their first cycle of IVF/ICSI to the Institute of Women, Children and Reproductive Health, Shandong University, from 2017 to 2020, including 1147 subjects in the MetS group and 7392 in the control group. The primary outcome was live birth. Secondary outcomes included other pregnancy outcomes and the risk of maternal and neonatal complications.

Women in the MetS group had a lower live birth rate (50.6% vs 54.9%, adjusted odds ratio [aOR] 0.87, 95% CI 0.75-1.00, P = .045) and higher risks of late miscarriage (5.8% vs 3.3%, aOR 1.52, 95% CI 1.02-2.27, P = .041), gestational diabetes mellitus (13.7% vs 7.0%, aOR 1.84, 95% CI 1.30-2.60, P = .001), hypertensive disorder of pregnancy (7.8% vs 3.5%, aOR 1.79, 95% CI 1.14-2.83, P = .012), and preterm birth (9.0% vs 4.4%, aOR 2.03, 95% CI 1.33-3.08, P = .001). Singleton newborns in the MetS group were at higher risk of large for gestational age (33.3% vs 20.5%, aOR 1.66, 95% CI (1.31-2.13), P < .001) but at lower risk of small for gestational age (2.7% vs 6.2%, aOR 0.48, 95% CI 0.25-0.90, P = .023).

MetS was associated with adverse IVF/ICSI outcomes in women without PCOS.

Recognizing the risk factors for dyslipidemia during pregnancy is crucial for safeguarding the health of both the mothers and the offspring. Growing evidence emerged and suggested links between environmental factors, including metals, and alteration in lipid levels or dyslipidemia in general populations. However, knowledge of the associations during pregnancy remains extremely lacking. Herein, we aimed to explore whether elevated metal exposure constitutes a risk factor for dyslipidemia in pregnant women. Based on the Tongji-Shuangliu Birth Cohort (TSBC), a total of 663 pregnant women were recruited and their urinary levels of 17 metals and blood lipid biomarkers in early pregnancy were measured, namely triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). The multivariable linear regression models revealed that exposure to selected metals during early pregnancy was significantly associated with some important biomarkers. In particular, after natural log-transformed for the levels of lipid biomarkers and metals, copper (Cu) exposure was positively associated with HDL-C (β = 0.024, 95% CI: 0.001, 0.046), while zinc (Zn) was associated with TG (β = 0.062, 95% CI: 0.013, 0.110) and selenium with TC (β = 0.028, 95% CI: 0.004, 0.054). Exposure to rubidium (Rb) was positively associated with multiple lipid biomarkers, including HDL-C (β = 0.020, 95% CI: 0.002, 0.037) and LDL-C (β = 0.022, 95% CI: 0.001, 0.042). Mixture exposure analysis further identified significant associations between Cu and HDL-C, Zn and TG, Rb and HDL-C, when multiple metal exposures were considered in the Bayesian kernel machine regression model simultaneously. Our findings showed that exposure to several metals during early pregnancy was associated with an increased prevalence of blood lipid abnormalities in pregnant women. These findings underscore the potential impact of metal combinations on lipid metabolism and increase our understanding of the risk factors associated with abnormal lipid metabolism during pregnancy.

Changes of maternal triglyceride concentrations are closely associated with intrauterine fetal growth and development, but the effect of mid- to late-term triglyceride changes on birth weight is uncertain. This study investigated the association between changes in triglycerides in mid to late in pregnant women gestational age ≥ 35 weeks on neonatal birth weight and adverse outcomes.

This cohort study was based on 931 pregnant women with a singleton delivery at gestational age ≥ 35 weeks from January 1, 2022 to December 31, 2022 at Nanjing Lishui People's Hospital (NJLSPH) in China, with all maternal triglyceride concentrations measured at mid-term and late-term before delivery. The primary outcomes were neonatal birth weight and the risk of macrosomia.

Late term triglyceride levels were positively associated with birth weight (β = 126.40, 95% CI: 61.95, 190.84, p < .001) and risk of macrosomia (OR = 2.11, 95% CI: 1.12, 3.98, p = .022). Late mid-term triglyceride was positively associated with birth weight (β = 27.58, 95% CI: 9.67, 45.50, p = .003), and no correlation with risk of macrosomia (OR = 1.12, 95% CI: 0.95, 1.31, p = .178). Mid-term triglyceride was not associated with birth weight (β = 45.79, 95% CI: -28.73, 120.30, p = .229) and risk of macrosomia (OR = 1.83, 95% CI: 0.89, 3.78, p = .101).

Late triglyceride levels were associated with birth weight and risk of macrosomia, while late to mid-term triglyceride were associated with birth weight but not with risk of macrosomia. This suggests that maternal triglyceride changes may affect fetal growth and development, and more studies focusing on the effects of gestational triglyceride profiles are warranted.

Thyroid hormone (TH) is essential for maintaining normal physiological processes during pregnancy, including the metabolism of energy materials in both the mother and fetus and the growth and development of fetal bone and nervous system. TH can act on the liver, fat, and other tissues and organs to participate in lipid synthesis and breakdown through multiple pathways. Consequently, abnormal thyroid function is often accompanied by lipid metabolism disorders. Both clinical and subclinical hypothyroidism, as well as dyslipidemia during pregnancy, have been shown to be associated with an increased risk of multiple adverse pregnancy outcomes. Recently, there has been an increased interest in studying the alteration of lipidomic and hypothyroidism (both clinical and subclinical hypothyroidism) during pregnancy. Studies have suggested that altered lipid molecules might be used as potential biomarker and associated with adverse maternal and neonatal outcome. Thus, we summarized the associations between lipid metabolism and clinical or subclinical hypothyroidism during pregnancy in this review. Then, we discussed the underlying mechanisms of thyroid dysfunction and lipid metabolism. In addition, we reviewed the possible effect of dyslipidemia on pregnancy and neonatal outcome. However, the relationship between hypothyroidism during pregnancy and changes in the lipid profile and how to intervene in the occurrence and development of adverse pregnancy outcomes require further study.

To evaluate maternal and neonatal outcomes in patients with intrahepatic cholestasis of pregnancy (ICP).

Patients who gave birth in our hospital between January 2018 and March 2022 were retrospectively reviewed from the hospital database and patient file records. The study comprised 1686 patients, 54 in the ICP group and 1632 controls. Patients who had ICP after 20 weeks of gestation and were monitored and delivered at our facility were enrolled. Maternal demographic and obstetric characteristics data were examined. Perinatal outcomes were also assessed. Logistic regression analysis was used to determine adverse maternal outcomes.

The mean age was 29 years. ART, GDM, and preeclampsia were significantly higher in the ICP group. The mean serum bile acid level was 19.3 ± 3 μmol/L in the ICP group. There was a higher risk of GDM and pre-eclampsia in women with ICP compared with those without and a significant association between ICP and adverse perinatal outcomes. There was a statistically significant relation between the presence of ICP and spontaneous preterm delivery, iatrogenic preterm delivery, 5th-minute Apgar scores < 7, and NICU requirement. No significant relationship was found between the presence of ICP and SGA and meconium. There was a significant relationship between the presence of ICP, mode of delivery, and PPH (p < 0.05). Those with ICP had a lower gestational week and birth weight, and higher rates of cesarean delivery and PPH.

ICP should prompt close monitoring and management to mitigate the potential exacerbation of adverse outcomes, including preeclampsia, GDM, and preterm birth.

The birth of large-for-gestational-age (LGA) infants is associated with many short-term adverse pregnancy outcomes. It has been observed that the proportion of LGA infants born to pregnant women with gestational diabetes mellitus (GDM) is significantly higher than that born to healthy pregnant women. However, traditional methods for the diagnosis of LGA have limitations. Therefore, this study aims to establish a predictive model that can effectively identify women with GDM who are at risk of delivering LGA infants.

To develop and validate a nomogram prediction model of delivering LGA infants among pregnant women with GDM, and provide strategies for the effective prevention and timely intervention of LGA.

The multivariable prediction model was developed by carrying out the following steps. First, the variables that were associated with LGA risk in pregnant women with GDM were screened by univariate analyses, for which the P value was < 0.10. Subsequently, Least Absolute Shrinkage and Selection Operator regression was fit using ten cross-validations, and the optimal combination factors were selected by choosing lambda 1se as the criterion. The final predictors were determined by multiple backward stepwise logistic regression analysis, in which only the independent variables were associated with LGA risk, with a P value < 0.05. Finally, a risk prediction model was established and subsequently evaluated by using area under the receiver operating characteristic curve, calibration curve and decision curve analyses.

After using a multistep screening method, we establish a predictive model. Several risk factors for delivering an LGA infant were identified (P < 0.01), including weight gain during pregnancy, parity, triglyceride-glucose index, free tetraiodothyronine level, abdominal circumference, alanine transaminase-aspartate aminotransferase ratio and weight at 24 gestational weeks. The nomogram's prediction ability was supported by the area under the curve (0.703, 0.709, and 0.699 for the training cohort, validation cohort, and test cohort, respectively). The calibration curves of the three cohorts displayed good agreement. The decision curve showed that the use of the 10%-60% threshold for identifying pregnant women with GDM who are at risk of delivering an LGA infant would result in a positive net benefit.

Our nomogram incorporated easily accessible risk factors, facilitating individualized prediction of pregnant women with GDM who are likely to deliver an LGA infant.

Intrahepatic cholestasis of pregnancy (ICP) can lead to many adverse pregnancy outcomes, and the influencing factors remain unclear at present. This study retrospectively analyzed clinical data from 1815 pregnant women with ICP and evaluated the relationship between ICP subtypes, gestational age at onset, and pregnancy outcomes. The results of this study show that during pregnancy, the levels of biochemical indicators (TBA, DBIL and ALT) in the serum of pregnant women initially diagnosed with subtypes of ICP were noted to constantly change, and the subtype of ICP and its severity also changed. The incidence of adverse pregnancy outcomes [meconium-stained amniotic fluid (MSAF), NICU transfer, Apgar score ≤ 7 at 1 min, and preterm birth] in patients with ICP1 (icteric type) was significantly higher than for patients with ICP2, ICP3 or ICP4. The preterm birth rate of early-onset ICP was higher than that of late-onset ICP in ICP1 and ICP3 subtypes. In conclusion, the outcome of pregnancy in women with ICP is closely related to the serum TBA level and ICP subtype, which should be recognized in the clinic.

Elevated maternal triglycerides (TGs) have been associated with excessive fetal growth. However, the role of maternal lipid profile is less studied in gestational diabetes mellitus (GDM). We aimed to study the association between maternal lipid profile in the third trimester and the risk for large-for-gestational-age (LGA) newborns in women with GDM. We performed an observational and retrospective study of pregnant women with GDM who underwent a lipid profile measurement during the third trimester. We applied a logistic regression model to assess predictors of LGA. A total of 100 singleton pregnant women with GDM and third-trimester lipid profile evaluation were included. In the multivariate analysis, pre-pregnancy BMI (OR 1.19 (95% CI 1.03-1.38), p = 0.022) and hypertriglyceridemia (OR 7.60 (1.70-34.10), p = 0.008) were independently associated with LGA. Third-trimester hypertriglyceridemia was found to be a predictor of LGA among women with GDM, independently of glycemic control, BMI, and pregnancy weight gain. Further investigation is needed to confirm the role of TGs in excessive fetal growth in GDM pregnancies.