Longitudinal changes in HDL-cholesterol concentration are associated with different risk factors in primiparous and nulliparous young women: The NHLBI Growth and Health Study (NGHS)

Metabolic outcomes in women 6 months and 2 years after preeclampsia versus normotensive pregnancy: A P4 study

Preeclampsia is associated with an increased risk of long-term cardiometabolic disease; however, little is known regarding metabolic factors in the early postpartum years potentially contributing to these health disparities. This study aimed to compare body composition, serum biochemical parameters, energy balance and diet 6 months and 2 years after normotensive pregnancy versus preeclampsia. This is the longitudinal metabolic sub-study of the Postpartum Physiology, Psychology and Paediatric cohort study. Women were assessed 6 months and 2 years after normotensive pregnancy (n = 118) and preeclampsia (n = 47). Metabolic measures included anthropometry, body composition via bioelectrical impedance analysis, serum biochemical parameters, diet via a food recall diary, and 24-h energy expenditure using SenseWear Armbands. Two years postpartum, women after preeclampsia continued to have significantly higher weight (median 67.1 kg vs. 63.1 kg, p = .04) compared to normotensive pregnancies, in addition to higher LDL cholesterol levels (2.7 ± 0.8 mmol/L vs. 2.4 ± 0.6 mmol/L, p = .03). These women were also more likely to have an elevated HOMA-IR score ≥2.08 (44% vs. 19%, p = .01). For all women in our study, waist-to-hip ratio, percent fat mass and activity-associated energy expenditure improved overtime. However, HDL cholesterol levels deteriorated, and excess saturated fat and sodium intake persisted from 6 months postpartum. Therefore, two years after preeclampsia, women remain at greater metabolic risk than their normotensive counterparts, with greater weight, LDL cholesterol and markers of insulin resistance, potentially contributing to long-term cardiovascular morbidity and requiring early intervention.

Maternal fibrinogen/fibrin degradation products to high density lipoprotein cholesterol ratio for predicting delivery of small and large for gestational age infants: a pilot study

BACKGROUND

The purpose of this pilot study was to investigate associations between fibrinogen/fibrin degradation products (FDP) to high density lipoprotein-cholesterol (HDL-C) ratio (FHR) of mothers and the risk of delivering large/small for gestational age (LGA/SGA) infants and to evaluate the predictive power of FHR on LGA/SGA.

METHODS

This study retrospectively reviewed 11,657 consecutive women whose lipid profiles and FDP levels were investigated at the time of admission for delivery at a specialized hospital. The FHR was calculated, and perinatal outcomes, including clinical parameters, were analyzed.

RESULTS

The prevalence of SGA was 9% (n = 1034), and that of LGA was 15% (n = 1806) in this cohort study. FHR was significantly lower in women who delivered SGA infants (4.0 ± 3.2 vs. 4.7 ± 3.3 mg/mmol, P < 0.01) and higher in women who delivered LGA infants (5.7 ± 3.8 vs. 4.7 ± 3.3 mg/mmol, P < 0.01) compared with those who delivered infants of normal size for their gestational age. Women in the top quartile for FHR (> 5.9 mg/mmol) had a 2.9-fold higher risk of delivering LGA infants [adjusted odds ratio (OR) = 2.9, P < 0.01] and a 47% lower risk of delivering SGA infants (adjusted OR = 0.47, P < 0.01) than those in the bottom quartile (< 2.7 mg/mmol). In addition, adding FHR to the conventional models significantly improved the area under the curve for the prediction of delivering LGA (0.725 vs. 0.739, P < 0.01) and SGA (0.717 vs. 0.727, P < 0.01) infants.

CONCLUSION

These findings suggest that the FHR calculated in late pregnancy is an innovative predictor of delivering LGA and SGA infants. Combining FHR with perinatal parameters could thus enhance the predictive ability for predicting the delivery of LGA/SGA infants.

Effects of dietary and exercise treatments on HDL subclasses in lactating women with overweight and obesity: a secondary analysis of a randomised controlled trial

Childbearing decreases HDL-cholesterol, potentially contributing to the increased risk of CVD in parous women. Large HDL particles (HDL-P) are associated with lower risk of CVD. In this secondary analysis of a randomised controlled trial, we investigated the effects of 12-week dietary and exercise treatments on HDL-P subclass concentration, size and apoA1 in lactating women with overweight/obesity. At 10-14 weeks postpartum, 68 women with pre-pregnant BMI 25-35 kg/m² were randomised to four groups using 2 × 2 factorial design: (1) dietary treatment for weight loss; (2) exercise treatment; (3) both treatments and (4) no treatment. Lipoprotein subclass profiling by NMR spectroscopy was performed in serum at randomisation and after 3 and 12 months, and the results analysed with two-way ANCOVA. Lipid concentrations decline naturally postpartum. At 3 months (5-6 months postpartum), both diet (P = 0·003) and exercise (P = 0·008) reduced small HDL-P concentration. Concurrently, exercise limited the decline in very large HDL-P (P = 0·002) and the effect was still significant at 12 months (15 months postpartum) (P = 0·041). At 12 months, diet limited the decline in very large HDL-P (P = 0·005), large HDL-P (P = 0·001) and apoA1 (P = 0·002) as well as HDL size (P = 0·002). The dietary treatment for weight loss and the exercise treatment both showed effects on HDL-P subclasses in lactating women with overweight and obesity possibly associated with lower CVD risk. The dietary treatment had more effects than the exercise treatment at 12 months, likely associated with a 10 % weight loss.

Roles of maternal HDL during pregnancy

BACKGROUND

High density lipoproteins (HDL) were first linked to cardiovascular disease (CVD) over 30 years ago when an inverse relationship was shown between CVD and HDL-cholesterol levels. It is now apparent that HDL composition and function, not cholesterol levels, are the pertinent measurements describing HDL's role in various disease processes, especially those with subclinical or overt inflammation.

SCOPE OF REVIEW

Pregnancy is also an inflammatory state. When inflammation becomes excessive during pregnancy, there is an increased risk for adverse outcomes that affect the health of the mother and fetus, including preterm birth and preeclampsia. Though studies on HDL during pregnancy are limited, recent evidence demonstrates that HDL composition and function change during pregnancy and in women with adverse outcomes.

GENERAL SIGNIFICANCE

In this review, we will discuss how HDL may play a role in maintaining a healthy pregnancy and how impairments in function could lead to pregnancies with adverse outcomes.