Maternal hyperlipidemia and the risk of preeclampsia: a meta-analysis

Abstract

Published reports examining lipid levels during pregnancy and preeclampsia have been inconsistent. The objective of this meta-analysis was to test the association between preeclampsia and maternal total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and triglyceride levels measured during pregnancy. We conducted a systematic search for studies published between the index date until July 2013 reporting maternal lipid levels in women with preeclampsia and normotensive pregnant women. Seventy-four studies met all eligibility criteria and were included in the meta-analysis. Weighted mean differences in lipid levels were calculated using a random-effects model. Statistical heterogeneity was investigated using the I(2) statistic. Meta-regression was used to identify sources of heterogeneity. Preeclampsia was associated with elevated total cholesterol, non-HDL-C, and triglyceride levels, regardless of gestational age at the time of blood sampling, and with lower levels of HDL-C in the third trimester. A marginal association was found with LDL-C levels. Statistical heterogeneity was detected in all analyses. Meta-regression analyses suggested that differences in body mass index (weight (kg)/height (m)(2)) across studies may be partially responsible for the heterogeneity in the triglyceride and LDL-C analyses. This systematic review and meta-analysis demonstrates that women who develop preeclampsia have elevated levels of total cholesterol, non-HDL-C, and triglycerides during all trimesters of pregnancy, as well as lower levels of HDL-C during the third trimester.

Keywords: body mass index; cholesterol; hyperlipidemia; hypertriglyceridemia; meta-analysis; preeclampsia; systematic review; triglycerides.

Figure 1.

Flow diagram of study selection for the meta-analysis of the association between lipid measurements during pregnancy and risk of preeclampsia (PE). “Main” refers to the main meta-analysis of lipid levels during pregnancy and risk of any PE. “Severe or mild” refers to the subanalysis of lipid levels during pregnancy and the risk of PE, stratified by PE severity. Overlap between the 2 meta-analyses is possible. Studies were published from the index date of the databases until July 2013. HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol.