Reduced low-density lipoprotein cholesterol levels are associated with increased risk of gestational diabetes mellitus in Chinese women

Lipid levels in women with gestational diabetes mellitus (GDM) have been extensively studied, whether low-density lipoprotein cholesterol (LDL-C) is a risk factor for GDM development remains unclear. This study aimed to investigate the correlation between serum LDL-C levels and the risk of GDM. A case-control study was conducted. Glycolipid metabolic and oxidative stress indicators were measured in 696 women with GDM and 1048 healthy pregnant women. Serum LDL-C levels were significantly lower in the GDM group than in the control group (P < 0.001). Subgroup analysis indicated that reduced LDL-C levels were associated with an increased risk of GDM after adjusting for differences in maternal age, pre-pregnancy body mass index (BMI), gestational age at sampling, fasting glucose and insulin levels, and homeostatic model assessment of insulin resistance (odds ratio [OR] 1.372, 95% confidence interval [CI] 1.050-1.794, P = 0.021 for medium-LDL-C subgroup; OR 1.672, 95% CI 1.219-2.294, P = 0.001 for low-LDL-C subgroup). The risk of GDM decreased by 17.6% per 1 mmol/L increase in LDL-C level (OR 0.824, 95% CI 0.733-0.926, P = 0.001). Furthermore, apolipoprotein (apo) A1 and high-density lipoprotein cholesterol (HDL-C) levels were lower, whereas pre-pregnancy and delivery BMI, triglyceride (TG)/HDL-C ratios, and second-trimester fasting glucose levels were higher in the low-LDL-C GDM subgroup than those in the high- and/or medium-LDL-C GDM subgroups (P < 0.05). ApoA1 and HDL-C levels were lower but TG/HDL-C ratios were higher in the medium-LDL-C GDM subgroup than those in the high-LDL-C GDM subgroup (P < 0.05). We concluded that reduced LDL-C levels were associated with an elevated risk of GDM in the study population. Low LDL-C levels correlated with increased BMI and unfavorable TG, HDL, and glucose metabolism.