Department of Obstetrics and Gynecology, University of Pittsburgh, 300 Halket Street, Pittsburgh, Pennsylvania 15213, USA.
J Clin Endocrinol Metab. 2010 Aug;95(8):3711-8. doi: 10.1210/jc.2009-2028. Epub 2010 May 25.
Preterm birth is associated with maternal cardiovascular risk, but mechanisms are unknown.
We considered that dyslipidemia may predispose women to both conditions and that prepregnancy lipids may be related to preterm birth risk. We hypothesized that low or high prepregnancy plasma lipids would be associated with preterm birth.
DESIGN, SETTING, AND PARTICIPANTS: A total of 1010 women (49% black) enrolled in the multicenter, prospective Coronary Artery Risk Development in Young Adults study with at least one singleton birth during 20 yr of follow-up were evaluated.
Postbaseline preterm births less than 34 wk or 34 to less than 37 wk vs. greater than 37 wk gestation.
We detected a U-shaped relationship between prepregnancy cholesterol concentrations and preterm birth risk. Women with prepregnancy cholesterol in the lowest quartile compared with the second quartile (<156 vs. 156-171 mg/dl) had an increased risk for preterm birth 34 to less than 37 wk (odds ratio 1.86; 95% confidence interval 1.10, 3.15) and less than 34 wk (odds ratio 3.04; 1.35, 6.81) independent of race, age, parity, body mass index, hypertension during pregnancy, physical activity, and years from measurement to birth. Prepregnancy cholesterol in the highest quartile (>195 mg/dl) was also associated with preterm birth less than 34 wk among women with normotensive pregnancies (odds ratio 3.80; 95% confidence interval 1.07, 7.57). There were no associations between prepregnancy triglycerides, low-density lipoprotein cholesterol, or high-density lipoprotein cholesterol and preterm birth.
Both low and high prepregnancy cholesterol were related to preterm birth risk. These may represent distinct pathways to the heterogeneous outcome of preterm birth. Additional studies are needed to elucidate mechanisms that link low or high cholesterol to preterm birth and later-life sequelae.
早产与母体心血管风险相关，但具体机制尚不清楚。
我们认为血脂异常可能使女性更容易同时出现这两种情况，而且孕前血脂可能与早产风险有关。我们假设低或高孕前血浆脂质与早产相关。
设计、地点和参与者：共有 1010 名（49%为黑人）女性参加了多中心前瞻性青年成人冠状动脉风险发展研究，在 20 年的随访期间至少有一次单胎分娩。
产后小于 34 周或 34 至小于 37 周与大于 37 周的早产。
我们发现孕前胆固醇浓度与早产风险之间呈 U 型关系。与第二四分位数（<156-171mg/dl）相比，胆固醇处于最低四分位数的女性（<156mg/dl），其早产 34 至小于 37 周（比值比 1.86；95%置信区间 1.10-3.15）和小于 34 周（比值比 3.04；1.35-6.81）的风险增加，且独立于种族、年龄、产次、体重指数、妊娠期间高血压、身体活动和从测量到分娩的时间。对于妊娠期间血压正常的女性，胆固醇处于最高四分位数（>195mg/dl）也与早产小于 34 周相关（比值比 3.80；95%置信区间 1.07-7.57）。孕前甘油三酯、低密度脂蛋白胆固醇或高密度脂蛋白胆固醇与早产无相关性。
低和高孕前胆固醇均与早产风险相关。这些可能代表了早产这一异质性结局的不同途径。需要进一步研究来阐明低或高胆固醇与早产和后期生活后果之间的联系机制。
