ORIGINAL ARTICLE
Hyperlipidemia of Pregnancy: Normal or Predictor
of Preeclampsia
Suman Chaudhary1, Manju Hiranwal2, Deepa Chaudhary3, Pradeep Dudi4
A B S T R AC T
Aim: Pregnant women develop physiological dyslipidemia that can be measured in the laboratory by the lipid indexes. The atherogenic lipid
profile of human gestation is further enhanced in preeclampsia. Our study has two purposes. First, the study of the alterations of total cholesterol
(TCH), triglycerides (TG), low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL), and high-density lipoprotein (HDL) during the
pregnancy. The values were compared between early and late pregnancy. Second, the values of women who remained normotensive throughout
pregnancy were compared to those who developed hypertension later on.
Materials and methods: A total of 500 pregnant women with gestational age of 20 weeks. All of them were followed till delivery and maternal
and fetal outcome was noted.
Results: Out of 500 pregnant women, 45 were lost to follow-up. The mean age of study population was 23.27 ± 3.54 years. A total of 47 (10.33%)
developed preeclampsia–22 had severe and 25 had mild hypertension. All plasma lipid levels increase as gestational age progresses except
HDL. This change is statistically significant. It is observed that pregnant women with high TCH and LDL levels at <20 weeks are more likely to
develop hypertension later (p value <0.05). Hypertensive pregnant women has very high TCH and LDL levels at >37 weeks (p value <0.05) as
compared to normotensive pregnant women.
Conclusion: Pregnancy, in general preeclamptic pregnancy, in particular is associated with marked hyperlipidemia. The study suggests that
alterations in lipid metabolism observed in preeclampsia are present at early gestational age <20 weeks. Any pregnant women with higher
plasma lipid levels may be observed and evaluated for preeclampsia.
Keywords: High-density lipoprotein, Lipid profile, Low-density lipoprotein, Preeclampsia, Pregnancy, Total cholesterol, Triglycerides.
Journal of South Asian Federation of Obstetrics and Gynaecology (2020): 10.5005/jp-journals-10006-1752
INTRODUCTION
Profound local and systemic changes in maternal physiology are
initiated by conception and continued throughout pregnancy.1
During early pregnancy, the maternal metabolic environment is
modified by a rise in serum levels of estrogen and progesterone,
pancreatic β-cell hyperplasia occurs, and there is an increase in the
secretion of insulin.2
As pregnancy advances, a well-integrated and systematic
metabolic shift occurs to provide sufficient and balanced supply
of nutrients to a constantly feeding fetus from an intermittently
fasting and feeding mother. Freinkel3 was the first to describe the
maternal metabolic changes of late pregnancy as “accelerated
starvation,” when food is unavailable, and “facilitated anabolism,”
when food is ingested. Chauffard4 in 1911 undertook the first
chemical study of blood lipids during pregnancy and suggested
that an increase occurs in the cholesterol level. Later on, multiple
studies demonstrated increase in various fractions of lipids and
lipid indices such as total cholesterol (TCH), triglycerides (TG), highdensity lipoprotein (HDL), low-density lipoprotein (LDL) and verylow-density lipoprotein (VLDL). That is, pregnant women develop
physiological hyperlipidemia.5
The alterations of serum lipid indices are associated with
the gestational age. The increase of the lipid and lipoprotein
metabolism reaches the level of cardiovascular risk6,7 during the
second trimester. In the later half of pregnancy, there is two- to
threefold increase in plasma triglycerides and lesser increase in
TCH, HDL-C, and LDL-C.
The hyperlipidemia of the second half of pregnancy may be a
purely physiological response or may be indicative of pathology
1–3
Department of Obstetrics and Gynecology, SMS Medical College,
Jaipur, Rajasthan, India
4
Department of Radio Diagnosis, Railway Hospital, Jaipur, Rajasthan,
India
Corresponding Author: Suman Chaudhary, Department of Obstetrics
and Gynecology, SMS Medical College, Jaipur, Rajasthan, India, Phone:
+91 9460077909, e-mail: drsuman1981@gmail.com
How to cite this article: Chaudhary S, Hiranwal M, Chaudhary D, et al.
Hyperlipidemia of Pregnancy: Normal or Predictor of Preeclampsia.
J South Asian Feder Obst Gynae 2020;12(1):31–33.
Source of support: Nil
Conflict of interest: None
in some women. In the present times, where prevalence of
cardiovascular diseases is on rise, we must evaluate whether the
hyperlipidemic response to pregnancy is a variable or not and if so,
whether it can predict future hyperlipidemia in a manner analogous
to that of impaired glucose tolerance during pregnancy, which can
predict DM in later life of women. There is evidence that triglyceride
concentration, if measured between 9 weeks and 12 weeks of
gestation, has moderate predictive value for subsequent glucose
tolerance in pregnancy. For that reason, further studies are needed
to investigate the role of early measurement in the screening and
management of cardiovascular damage.8,9
Late pregnancy is associated with the formation of susceptible,
oxidizable particles and an increase in oxidative damage. These
biochemical changes may be relevant for the long-term cardiovascular
health of women, especially those of high parity who are at high risk
for cardiovascular disease (e.g., women with diabetes).9,10
© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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Hyperlipidemia of Pregnancy
Preeclampsia accentuates atherogenic lipid profile changes
associated with human gestation, which may be a potential
contributor to endothelial cell dysfunction. Studies have shown9,11
that in preeclampsia, the plasma lipids profile is substantially above
levels seen in normal pregnancies. Such lipid changes may play
a role in the endothelial damage characteristic of preeclampsia.
Our study aimed to address two objectives:
First, the study of the alterations of TCH, TG, LDL,VLDL, and
HDL during the pregnancy, i.e., at <20 weeks and at >37 weeks.
The values were compared between early and late pregnancy and
analyzed.
Second, the values of women who remained normotensive
throughout pregnancy were compared to those who developed
hypertension later on at both early and late pregnancy.
M AT E R I A L S
AND
Table 2: Variation in plasma lipid profile during pregnancy
Parameters (mg/dL)
TG
TCH
HDL
LDL
VLDL
Parameters (mg/dL)
TG
TCH
HDL
LDL
VLDL
•
•
•
•
•
•
Table 1: Distribution of cases according to parity and age
Age/parity
<20 years
21–25 years
26–30 years
>30 years
Total
Primigravida
83
68
52
10
213
Multigravida
6
165
64
7
242
The mean age of study population was 23.27 ± 3.54 years
32
Total
89
233
116
17
455
Normotensive
168.77 ± 31.66
182.95 ± 38.79
43.50 ± 13.78
103.022 ± 3.85
21.25 ± 6.10
Hypertensive
175.00 ± 39.90
200.82 ± 40.15
39.00 ± 4.76
125.82 ± 31.75
28.36 ± 7.01
p value
0.188
0.008
0.297
0.015
0.602
It is clear that pregnant women with high TCH and LDL levels at 20 weeks
are more likely to develop hypertension later (p value < 0.05)
Table 4: Comparison of plasma lipid profile at >37 weeks in normotensive
pregnant women and pregnant women developing hypertension
Parameters (mg/dL)
TG
TCH
HDL
LDL
VLDL
Out of 500 pregnant women, 45 were lost to follow-up.
The mean age of study population was 23.27 ± 3.54. A total
of 233 (51.21 %) of study population were of age 21–25 years.
A total of 242 (53.19%) of women were multigravidas and 213
(46.81%) were primigravidas.
Out of 455 women, 47 (10.33%) developed gestational
hypertension—22 had severe hypertension and 25 had mild
hypertension.
Out of 455 women, 23 (5.06%) had IUGR fetus.
All lipid lipoprotein levels increase as gestational age
progresses except HDL. This change is statistically significant
too (Tables 1 and 2).
Comparison of the plasma lipid profile at <20 weeks in
normotensive pregnant women and pregnant women
developing hypertension shows that pregnant women who
developed hypertension later on had higher levels of TG, TCH,
LDL, VLDL, and low levels of HDL (Table 3).
It is clear that pregnant women with high TCH and LDL levels
at 20 weeks are more likely to develop hypertension later
(p value < 0.05).
p value
0.0001
0.0001
0.0001
0.005
0.009
Table 3: Comparison of plasma lipid profile at <20 weeks in normotensive
pregnant women and pregnant women developing hypertension
R E S U LTS
•
>37 weeks
179.41 ± 46.31
201.26 ± 48.57
36.70 ± 5.89
120.89 ± 26.97
29.91 ± 6.77
All lipid lipoprotein levels increase as gestational age progresses except
HDL. This change is statistically significant too
METHODS
A total of 500 pregnant women with gestational age <20 weeks
were enrolled for study after informed consent. Fasting venous
blood samples were collected into plain tubes and subjected
to estimation of the lipid profile by following methods: serum
cholesterol by the modified Roeschlau’s method, serum triglyceride
by the McGrowan method, HDL-C by the Bursteim et al. method,
and VLDL and LDL-C was calculated by Friedewald’s formula.
Estimation of the lipid profile was repeated at gestational age >37
weeks. All of them were followed till delivery and the maternal and
fetal outcome was noted.
<20 weeks
162.58 ± 68.31
187.40 ± 36.87
40.11 ± 7.74
115.83 ± 28.0.36
26.24 ± 29.29
Normotensive
184.74 ± 49.80
213.01 ± 57.23
38.14 ± 6.22
110.80 ± 19.92
30.19 ± 7.18
Hypertensive
194.95 ± 50.52
302.38 ± 52.60
37.76 ± 5.53
127.44 ± 33.51
31.70 ± 8.79
p value
0.188
0.0001
0.297
0.010
0.602
Pregnant women with hypertension have very high TCH and LDL levels
at >37 weeks (p value < 0.05) as compared to normotensive pregnant
women
•
•
Table 4 shows comparison of the plasma lipid profile at >37
weeks in normotensive pregnant women and pregnant women
with hypertension. All lipid levels are highly elevated in women
with hypertension.
Pregnant women with hypertension have very high TCH
and LDL levels at >37 weeks (p value < 0.05) as compared to
normotensive pregnant women.
DISCUSSION
Age is one of the important factors that affects the serum lipid
profile. In the present study, the mean age of study population was
23.27 ± 3.54 years. A total of 233 (51.21 %) of study population were
of age 21–25 years; thus, most of them were young.
In our study, we found that all lipid indices increase with
increasing gestational age; however, a drop in HDL was observed.
This change is highly significant (p value < 0.05).
This finding is in congruence with studies done by Parchwani
et al.,12 Kumar et al.,13 and Blessings et al.9 Similar to our study results,
several other studies conducted by Fahraeus et al.,14 Jimenez et al.,15
and Potter and Neste16 reported similar observations. The principal
modulator of this hypertriglyceridemia is estrogen as pregnancy
is associated with hyperoestrogenemia. Estrogen induces hepatic
Journal of South Asian Federation of Obstetrics and Gynaecology, Volume 12 Issue 1 (January–February 2020)
Hyperlipidemia of Pregnancy
biosynthesis of endogenous triglycerides, which is carried by
VLDL.17 This process may be modulated by hyperinsulinemia found
in pregnancy.18
We observed that pregnant women with high TCH (p value
0.008) and high LDL (p value 0.015) at gestational age <20 weeks
were more likely to develop preeclampsia as compared to women
with normotensive pregnancy. This observation suggests a positive
association between pregnancy-induced hyperlipidemia and
subsequent risk of preeclampsia. Similar results were observed in
studies by Gratacos et al.,19 Deshpande et al.,20 Singh et al.21
We also observed that pregnant women with preeclampsia
had high plasma lipid levels, especially TCH (p value < 0.0001) and
LDL (p value < 0.001), at gestational age >37 weeks as compared to
normotensive pregnant women. This observation supports role of
pregnancy-induced hyperlipidemia in preeclampsia.
C O N C LU S I O N
The study results suggest that pregnancy–induced hyperlipidemia
observed in preeclampsia is present at early gestational age (<20
weeks). Our results suggested that maternal hyperlipidemia was
significantly associated with risk of developing preeclampsia. Any
pregnant women detected with higher serum plasma lipid levels in
early gestation may be observed and evaluated for preeclampsia.
It may also have long-term effect on health of women and lead
to significant risk of development of obesity, atherosclerosis, type 2
diabetes mellitus, etc. Therefore, it is advisable to screen pregnant
women for the serum lipid profile.
REFERENCES
1. Kortenoever M. Physiological changes in pregnancy . Int J Contemp
Med Res 1960;21:443–445.
2. Kalkhoff RK. Metabolic effects of progesterone. Am J Obst Gynae
1982;142(6):735–737. DOI: 10.1016/S0002-9378(16)32480-2.
3. Freinkel N. Effect of the conceptus on maternal metabolism during
pregnancy. Excerpta Med 1964;12:679–681.
4. Chauffard A, Laroche G, Grigaut A. Blood lipids in pregnancy.
Obstetriqie 1911;4:481–482.
5. Merabishvili V, Kambladze O, Sulaberidze T. Peculiarities of lipid
metabolism during pregnancy. Georgian Med News 2006;138:86–89.
6. Lippi G, Albiero A, Montagnana M, et al. Lipid and lipoprotein profile
in physiological pregnancy. Clin Lab 2007;53(3–4):173–177.
7. Loke DF, Viegas OA, Kek LP, et al. Lipid profiles during and after
pregnancy. Gynecol Obstet Invest 1991;32(3):144–147. DOI:
10.1159/000293016.
8. Brizzi P, Tonolo G, Esposito F, et al. Lipoprotein metabolism during
normal pregnancy. Am J Obstet Gynecol 1999;181(2):430–434. DOI:
10.1016/s0002-9378(99)70574-0.
9. Okojie FO, Blessing IO, Mable AE, et al. Comparative study of lipid
profile of normal pregnant women in the different trimesters. Arch
Appl Sci Red 2011;3(3):528–532.
10. Martin U, Davies C, Hayavi S, et al. Is normal pregnancy atherogenic?
Clin Sci (Lond) 1999;96(4):421–425. DOI: 10.1042/cs0960421.
11. Bodnar M, Ness B, Hanger F, et al. Inflammation and triglycerides
partially mediate the effect of pre-pregnancy body mass index on
the risk of preeclampsia. Am J Epidemiol 2005;162(12):1198–1206.
DOI: 10.1093/aje/kwi334.
12. Parchwani D, Patel D. Status of lipid profile in pregnancy. Nat J Med
Res 2011;1(1):10–12.
13. Kumar S, Dadheech G, Gupta RC. Dyslipidemia in pregnancy in a
rural population in North India. Int Res J Biochem Biotech 2014;1(1):
002–004.
14. Fahraeus L, Larsson-Cohn U, Wallentin L. Plasma lipoproteins
including high density lipoprotein subfractions during normal
pregnancy. Obstet Gynecol 1995;66:468–472.
15. Jimenez DM, Pocovi M, Ramon C. Longitudinal study of plasma lipids
and lipoprotein cholesterol in normal pregnancy and puerpurium.
J Gynecol Obstet Invest 1988;25(3):158–164. DOI: 10.1159/000293765.
16. Potter JM, Neste PJ. The hyperlipidemia of pregnancy in normal and
complicated pregnancies. Am J Obstet Gynecol 1979;133(2):165–179.
DOI: 10.1016/0002-9378(79)90469-1.
17. Glueck CJ, Fallet RW, Scheel D. Effects of oestrogenic compounds
on triglycerides kinetics. Metabolism 1975;24(4):537–545. DOI:
10.1016/0026-0495(75)90078-5.
18. Adegke OA, Iyare EE, Gbenebitse SO. Fasting plasma glucose and
cholesterol levels in pregnant Nigerian women. Niger Postgrad Med
J 2003;10(1):32–36.
19. Gratacos E, Casals E, Gomez O, et al. Increased susceptibility to
low density lipoprotein oxidation in women with a history of
preeclampsia. BJOG 2003;110(4):400–404. DOI: 10.1046/j.14710528.2003.02349.x.
20. Deshpande H, Chandtakant M, Poonam V, et al. Study of serum
lipid profile in pregnancy induced Hypertension. Indian J Appl Res
2016;6:546–548.
21. Singh DU, Yadav S, Mehrotra S, et al. Serum lipid profile in early
pregnancy as a predictor of preeclampsia. Int J Med Res Rev
2013;1(02). DOI: 10.17511/ijmrr.2013.i02.03.
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