Lipid profile analysis during pregnancy and its association with adverse pregnancy outcomes: a retrospective cohort study

Abstract Background Lipids are crucial elements in maintaining normal pregnancy. Trimester-specific kinetics of maternal lipid levels in normal pregnancy and pregnancy with adverse outcomes remain insufficiently characterized. Methods This retrospective cohort study analyzed 5,657 singleton pregnancies recruited between January 1st, 2023 and June 30th, 2024. Serum triglycerides (TG), total cholesterol (TC), Low-density lipoprotein (LDL) and High-density lipoprotein (HDL) were measured at the first, second and third trimesters individually. The Generalized Additive Models for Location Scale and Shape (GAMLSS) was applied in generating the gestational-specific lipid percentile curves. Statistical analysis was performed by using SPSS. Two-tailed p < 0.05 was defined as statistical significance. Results In normal pregnancy, lipids increased with gestational age, with the fastest kinetic in TG and the highest value in TC. In pregnancies with gestational diabetes mellitus (GDM), preeclampsia (PE), preterm birth (PTB), large-for-gestational-age (LGA) and macrosomia, TG were elevated significantly across all trimesters, as compared to normal pregnancy, in case of small-for-gestational-age (SGA) vice versa. TC levels at the first trimester were higher in GDM, PE, PTB, LGA, and macrosomia compared to normal pregnancy, yet lower in GDM at the second and third trimesters. Multivariable logistic regression analysis identified TG and TC levels at the first trimester as independent risk factors for GDM, PE and PTB. In addition, TG levels at all trimesters were associated with an increased risk of LGA and macrosomia, while TC at the second and third trimester was negatively correlated with SGA. Conclusions This study provided trimester-specific lipid levels during normal pregnancy and pregnancy with complications, contributing to clinical reference. Furthermore, lipid related risk factors for gestational diseases have been identified, which add new insights to the development of gestational complications and clinical management.