Associations Between Maternal Lipid Profile During Early Pregnancy And Gestational Diabetes In Xiangxi Area

Objective:To investigate the situation of early pregnancy blood lipid levels of pregnant women in Xiangxi,Hunan,compare the blood lipid levels between pregnant women with gestational diabetes and healthy pregnant women,and explore the correlation between early pregnancy blood lipid levels and the risk of gestational diabetes.To investigate whether the detection of early pregnancy blood lipids can be early predictors of pregnant women with gestational diabetes and its predictive ability.It provides scientific reference for the management of blood lipid in early pregnancy,early prediction and intervention of gestational diabetes mellitus in clinical work.Methods:Pregnancy clinical data of 1776 pregnant women who were registered,examined and hospitalized for delivery in the People’s Hospital of Xiangxi Autonomous Prefecture from March 1,2020 to February 28,2021 were collected.According to the requirements of the study,strict inclusion and exclusion criteria were formulated,and 254 pregnant women were finally included in the study.All these pregnant women received fasting blood lipid test at 11-13⁺⁶weeks of gestation in our hospital,and 75g glucose tolerance test at24-28 weeks of gestation in our hospital to determine whether they were diagnosed with gestational diabetes mellitus.They were divided into two groups according to whether they had gestational diabetes mellitus.Among them,pregnant women with gestational diabetes were the case group（102cases）,and healthy pregnant women were the control group（152 cases）.Collect and analyze the clinical data of these two groups of pregnant women,including:age,ethnicity,education level,place of residence,pre-pregnancy Body mass index（BMI）,cesarean section history,pregnancy times,parity,family history of diabetes,and blood lipid level in early pregnancy family history of diabetes,and early pregnancy blood lipid levels（triglycerides,total cholesterol,high-density lipoprotein and low-density lipoprotein）and 75g glucose tolerance experiment results.Then,we employed univariate and multivariate Logistic regression analysis to study the correlation between blood lipid levels in early pregnancy and gestational diabetes.After Logistic regression model was established,the model receiver operating characteristic curve（ROC）was ploted to analyze the clinical predictive value of blood lipid level in early pregnancy on the occurrence of gestational diabetes.Results:（1）The study finally included 254 pregnant women,152 pregnant women in the control group,and 102 pregnant women in the case group.（2）Comparison results of general features showed that there was no statistical difference in the ethnicity,education level,pre-pregnancy BMI,times of pregnancy,parity,whether there was a history of cesarean section,and whether the two groups of pregnant women were primiparous（P>0.05）;The age,place of residence,and family history of diabetes between the two groups were statistical differences（P values were 0.038,0.004,0.034,respectively）.（3）The univariate analysis results of early pregnancy blood lipid in the two groups demonstrated that the average triglyceride value of the case group was1.660（1.310,2.033）mmol/L,the control group was 1.360（1.093,1.863）mmol/L,and its Z value was 8.209,P value is 0.004,the difference is statistically significant.The average total cholesterol in the case group was 5.203±0.806mmol/L,and the control group was 4.712±0.769 mmol/L,with a t value of 4.893and a P value of<0.001,the difference was statistically significant.The average value of HDL in the case group was 1.587±0.382 mmol/L,and the control group was 1.803±0.373 mmol/L,the t value was-4.77,and the P value was<0.001,and the difference was statistically significant.The average value of LDL in the case group was 2.708±0.572 mmol/L,and the control group was 2.428±0.567mmol/L,the t value was 3.844,and the P value was<0.001,and the difference was statistically significant.（4）After adjusting for age,residence and family history of diabetes,the results of multivariate logistic regression analysis showed that:（1）The association between triglycerides and gestational diabetes is not statistically significant,and it is temporarily unable to explain that triglycerides are an independent risk factor for gestational diabetes（OR=1.178,95%CI:0.855-1.624）;（2）The association between total cholesterol and gestational diabetes is still statistically significant,indicating that total cholesterol is an independent risk factor for gestational diabetes.As the total cholesterol concentration increases,the risk of gestational diabetes will also increase.（OR=2.177,95%CI:1.498-3.164）;（3）The association between HDL and gestational diabetes is still statistically significant,indicating that HDL is an independent protective factor for gestational diabetes.The increase in concentration reduces the risk of gestational diabetes（OR=0.190,95%CI:0.089-0.406）;（4）The association between HDL and gestational diabetes is still statistically significant,indicating that LDL is an independent cause of gestational diabetes risk factors,increased low-density lipoprotein concentration is associated with an increased risk of gestational diabetes（OR=2.305,95%CI:1.417-3.748）.The results of drawing the model receiver operating characteristic curve（ROC）showed that the area under the curve of total cholesterol,high-density lipoprotein,low-density lipoprotein and the combined detection of the three to predict GDM were 0.68,0.644,0.656,and0.809,respectively.Total cholesterol,high-density lipoprotein,and low-density lipoprotein combined predictors have certain predictive value for the occurrence of gestational diabetes.Conclusion:The increase of high-density lipoprotein in the first trimester may be related to the decreased risk of gestational diabetes;and the increase of total cholesterol and low-density lipoprotein may be related to the increased risk of gestational diabetes.The combined predictive indexes of total cholesterol,high-density lipoprotein,and low-density lipoprotein in early pregnancy have a certain predictive value for the occurrence of gestational diabetes.In the early pregnancy management of pregnant women,attention should be paid to the detection of blood lipid levels.Pregnant women with abnormal blood lipid levels should carry out lifestyle interventions in the early pregnancy to reduce the incidence and harm of gestational diabetes.