Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
Am J Perinatol. 2020 Jul;37(9):914-923. doi: 10.1055/s-0039-1689000. Epub 2019 Jun 2.
We characterized lipid trajectories and investigated lipids and rate of pregnancy lipid change with the risk of pregnancy loss or preterm delivery <37 weeks.
In a secondary analysis of 337 women with one to two prior losses assigned to placebo in a randomized controlled trial at four centers (2007-2012), cholesterol, low- and high-density lipoprotein cholesterol (HDL-C), and triglycerides were measured up to 6 months prepregnancy (time 0) and pregnancy up to 7 visits. Trajectories were created using linear mixed models. Multivariable logistic regression with adjustment for maternal characteristics and cholesterol was performed.
Lipids decreased from prepregnancy to 4 to 5 weeks, followed by an increase, and were biphasic or triphasic depending on the lipid component. Between 4 and 8 weeks, for every 1-unit increase in HDL-C, there was a 22% decreased odds of loss <14 weeks (odds ratio: 0.78; 95% confidence interval: 0.60, 0.99) and 24% decreased odds of loss or preterm delivery 14 to <37 weeks (odds ratio: 0.76; 95% confidence interval: 0.60, 0.96).
There were no associations with other lipid components or other time points. An impaired rise of HDL-C early in pregnancy may signal maladaptation to pregnancy that is associated with pregnancy loss or preterm delivery.
本研究旨在描绘脂质轨迹，并探讨脂质及其妊娠期间脂质变化率与妊娠丢失或早产（<37 周）的风险之间的关系。
本研究是对在四个中心（2007-2012 年）进行的一项随机对照试验中，1-2 次妊娠丢失且被随机分配至安慰剂组的 337 名女性进行的二次分析。在妊娠前最多 6 个月（时间 0）和妊娠期间最多 7 次就诊时，测定胆固醇、低和高密度脂蛋白胆固醇（HDL-C）和甘油三酯。采用线性混合模型构建轨迹。采用多变量逻辑回归，对母体特征和胆固醇进行调整。
脂质从妊娠前到 4-5 周时下降，随后增加，且取决于脂质成分呈双相或三相。在 4-8 周期间，HDL-C 每增加 1 个单位，14 周内丢失的几率降低 22%（优势比：0.78；95%置信区间：0.60，0.99），14-<37 周丢失或早产的几率降低 24%（优势比：0.76；95%置信区间：0.60，0.96）。
与其他脂质成分或其他时间点均无相关性。妊娠早期 HDL-C 升高不良可能提示妊娠适应不良，与妊娠丢失或早产有关。
