Study On The Correlation Between Glucose And Lipid Metabolism During Pregnancy And Perinatal Outcome

Objective:To investigate the correlation between serum lipid levels and perinatal outcome during pregnancy and the changes of glucose and lipid metabolism.Methods:A prospective cohort study was conducted to investigate 934 pregnant women who were enrolled in the Affiliated Hospital of North Sichuan Medical College from October 2019 to October 2020.Serum levels of total cholesterol(TC),triglyceride(TG),High density lipoprotein cholesterol(HDL-C),Low density lipoprotein cholesterol(LDL-C),and Apolipoprotein A(ApoA),Apolipoprotein B(ApoB),and blood glucose levels were measured in early,middle,and late gestation,as well as before parturition.The variation trend of blood lipid in early,middle,late pregnancy and early partum and the difference between groups were analyzed,and the reference range of blood lipid during pregnancy was preliminarily discussed.To analyze the relationship between abnormal blood lipids and blood glucose and maternal and fetal general condition and pregnancy complications.Results:1 Compared with the early pregnancy,with the increase of gestational weeks,the levels of TG,TC,LDL-C and ApoB increased significantly,especially the changes of TG were obvious,and the level of TG in the early parturition could reach 2.6 times of that in the early pregnancy.The levels of HDL-C and ApoA increased from the first trimester to the second trimester,and then decreased gradually,but the overall level still increased.2 The abnormal rates of TG,TC,HDL-C and LDL-C in early pregnancy were 12.5%,6.3%,0.6%and 1.2%,respectively,compared with the standard of normal adult dyslipidemia.The abnormal rates of TG,TC,HDL-C and LDL-C in the second trimester were 56.4%,45.4%,1.2%and 6.6%,respectively.The abnormal rates of TG,TC,HDL-C and LDL-C in late pregnancy were 81.2%,59.7%,0.6%and 14.9%,respectively.The abnormal rates of TG,TC,HDL-C and LDL-C were 91.3%,49.6%,1.5%and 16.1%,respectively.In general,with the increase of gestational weeks,the rate of dyslipidemia has a trend of gradual increase.3 Through the analysis of blood lipid levels in 335 normal pregnant women during pregnancy,the reference range of blood lipid in normal pregnant women in the area may be as follows:TG:0.7～2.7mmol/L,TC:3.44～6.57mmol/L,HDL:1.34～2.45mmol/L,LDL:1.43～3.20mmol/L in early pregnancy;In the second trimester,TG was 1.4-4.29 mmol/L,TC was 4.5-8.18 mmol/L,HDL was 1.46-2.83 mmol/L,and LDL was 1.99-4.32 mmol/L.Late pregnancy:TG:1.83-5.26 mmol/L,TC:4.82-8.97 mmol/L,HDL:1.42-2.79 mmol/L,LDL:2.32-4.79 mmol/L;Before delivery,TG was 2.13～6.86mmol/L,TC was 4.48～8.81mmol/L,HDL was 1.34～2.66mmol/L,LDL was 1.67～5.28mmol/L.4 Compared with the normal pregnant women and the pregnancy complications group,the levels of HDL in the pregnant women with hypertensive disorders of pregnancy(HDP)were lower in the early,middle,late,and before delivery.The levels of TG in pregnant women with gestational diabetes mellitus(GDM)in early,middle,late pregnancy and before delivery were higher than those in normal pregnant women,while the levels of HDL were lower than those in normal pregnant women.Compared with normal pregnant women,the levels of TG in the pregnant women with intrahepatic cholestasis of pregnancy(ICP)before delivery were increased,while the levels of HDL and ApoA were decreased,the difference was statistically significant,and there was no significant difference between the groups in the rest of pregnancy.There was no significant difference in blood lipid levels between the pregnant women with hypothyroidism and the macrosomia group during pregnancy and the normal pregnant women.5 There were statistically significant differences in maternal age,pre-pregnancy BMI,weight gain during pregnancy,number of pregnancies,and number of births among the four groups(normal blood lipid and blood glucose level,abnormal blood lipid and blood glucose level,normal blood lipid and blood glucose level,abnormal blood lipid and blood glucose level,normal blood glucose level,abnormal blood lipid and blood glucose level),while there were no statistically significant differences in newborn sex and weight among the four groups.6 Glucolipid metabolism between four different combination pregnancy complications and fetal adverse outcomes comparison,HDP,ICP,FGR comparative differences between groups was statistically significant,pregnancy with macrosomia,premature rupture of membranes,postpartum hemorrhage,premature birth,abnormal amniotic fluid II and above water pollution,sheep(hydramnios,oligohydramnios),neonatal asphyxia,cesarean section rate,etc.There was no statistically significant difference is compared between four groups.7 There was no significant difference in the number of dyslipidemia,pregnancy complications and fetal adverse outcomes among pregnant women with abnormal blood lipid during middle and late pregnancy,including HDP,ICP,macrosomia,postpartum hemorrhage,premature rupture of membranes,premature delivery,cesarean section,neonatal asphoxia,fetal distress,and abnormal amniotic fluid.However,with the increase of the number of dyslipidemia,the incidence of ICP,postpartum hemorrhage,premature rupture of membranes,cesarean section rate,neonatal asphyxia and so on increased gradually.There was significant difference between the three groups in amniotic fluid II and above pollution(P<0.05).Conclusion:1 In pregnant women,TC,TG,LDL and HDL all increased to varying degrees with the increase of gestational months,especially TG.2 Compared with the standard of normal adult dyslipidemia,the rate of dyslipidemia during pregnancy is extremely high.We should not only use this standard to determine and intervene,but need to develop a diagnostic standard suitable for China’s pregnant women with dyslipidemia.3 The blood lipid indexes during pregnancy often show skewed distribution,and percentile method should be used to establish the reference interval.This study preliminaries established the reference range of TG,TC,HDL and LDL for pregnant women in different pregnancies in the area,which has certain clinical reference value.4 Pregnancy complications are often accompanied by dyslipidemia(such as HDP,GDM,ICP,etc.),which may be the inducement or aggravating factor of the disease.5 Blood lipid and blood glucose are closely related.In clinical work,blood glucose and blood lipid should be integrated to judge the condition,so as to better guide clinical practice.