Hyperglycemia and Adverse Pregnancy Outcome Study: Neonatal Glycemia

Introduction: Combinations of risk factor levels typically contribute more to population burdens of disease than single adverse risk factors. CVH (as defined by the AHA) characterizes a range of health levels, but its significance in pregnancy for obstetric and neonatal outcomes is unknown. Methods: Data from the Hyperglycemia and Adverse Pregnancy Outcome Study were analyzed, including 1,754 mother-child dyads from 9 field centers in 6 countries: US (26%), Barbados (24%), UK (20%), China (15%), Thailand (8%), and Canada (7%). Maternal CVH was scored (0-10 points, with 10 most favorable) at a mean of 28 (range 23-34) weeks’ gestation using 5 metrics ( Table ). Cord blood was collected at delivery, neonatal anthropometrics were measured within 72 hours, and medical records were abstracted for obstetric outcomes. Logistic regression was utilized to test associations of gestational CVH with obstetric and neonatal outcomes, adjusted for center and maternal and infant characteristics ( Table footnote). Results: The mean gestational CVH score was 8.2 (SD 1.5) out of 10; 18% of mothers had all ideal, 37% had 1+ intermediate, 34% had 1 poor, and 9% had 2+ poor metrics. In fully adjusted models ( Table ), odds ratios per 1 point higher (better) CVH score were 0.65 (95% CI, 0.56-0.76) for preeclampsia, 0.89 (0.78-1.00) for unplanned primary cesarean section (among primiparous mothers), 0.84 (0.77-0.93) for large for gestational age infant, 0.87 (0.79-0.97) for infant sum of skinfolds >90 th percentile, and 0.77 (0.69-0.86) for infant insulin sensitivity index (20/[C-peptide*glucose]) <10 th percentile. CVH categories were also associated with outcomes; for example, compared with mothers with all metrics ideal, odds ratios for preeclampsia were 2.00 (0.71-7.14) for mothers with 1+ intermediate, 4.34 (1.63-15.09) for mothers with 1 poor, and 9.40 (3.22-34.52) for mothers with 2+ poor metrics. Conclusion: More favorable levels of gestational CVH were associated with healthier obstetric and neonatal outcomes in this multinational cohort.

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Abstract P176: Associations of Gestational Lipids and Apolipoproteins With Pregnancy Outcomes: The Hyperglycemia and Adverse Pregnancy Outcome Study

Circulation ◽

10.1161/circ.141.suppl_1.p176 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Amanda M Perak ◽

Alan Kuang ◽

Nicola Lancki ◽

Darwin R Labarthe ◽

Svati H Shah ◽

...

Keyword(s):

Blood Pressure ◽

Pregnancy Outcome ◽

Gestational Age ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcome ◽

Late Pregnancy ◽

Large For Gestational Age ◽

Obstetric Outcomes ◽

Outcome Study ◽

Adverse Pregnancy

Introduction: Gestational hyperlipidemia has traditionally been considered physiologic and benign, but the significance of inter-individual variation in lipid levels for maternal-fetal health are poorly understood. We examined associations of gestational lipids and apolipoproteins with adverse obstetric and neonatal outcomes. Methods: Data from the Hyperglycemia and Adverse Pregnancy Outcome Study were analyzed, including 1,813 mother-child dyads from 9 field centers in 6 countries: US (25%), Barbados (24%), UK (20%), China (16%), Thailand (8%), and Canada (7%). Fasting lipids and apolipoproteins were directly measured at a mean of 28 (range 23-34) weeks’ gestation. Cord blood was collected at delivery, neonatal anthropometrics were measured within 72 hours, and medical records were abstracted for obstetric outcomes. Logistic regression was utilized to test associations of lipids and apolipoproteins (per +1 SD; log-transformed if skewed) with pregnancy outcomes, adjusted for center, demographics, and maternal covariates such as BMI, blood pressure, and glycemia. Results: See Table for lipid and apolipoprotein levels in pregnant mothers. In fully adjusted models ( Table ), 1 SD higher log-triglycerides (i.e., ~2.7-fold higher triglyceride level) in late pregnancy was significantly associated with higher odds for preeclampsia (OR 1.53 [95% CI, 1.15-2.05]), large for gestational age infant (1.42 [1.21-1.67]), and infant insulin sensitivity <10 th percentile (1.25 [1.03-1.50]), but not with unplanned primary cesarean section or infant sum of skinfolds >90 th percentile. There were no significant associations of maternal HDL-C, LDL-C, or log-ApoB/A1 ratio with any outcome. Conclusion: Triglyceride levels in the latter half of pregnancy were uniquely associated with both maternal risks (preeclampsia) and neonatal risks (large for gestational age and insulin resistance), even after adjustment for maternal BMI, blood pressure, and glycemia.

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