Early postpartum dyslipidemia and its potential predictors during pregnancy in women with a history of gestational diabetes mellitus

Abstract

Background: This study aimed to analyze the incidence of early postpartum dyslipidemia and its potential predictors in women with a history of gestational diabetes mellitus (GDM).

Methods: This was a retrospective study. Five hundred eighty-nine women diagnosed with GDM were enrolled and followed up at 6-12 weeks after delivery. A 75 g oral glucose tolerance test (OGTT) and lipid levels were performed during mid-trimester and the early postpartum period. Participants were divided into the normal lipid group and dyslipidemia group according to postpartum lipid levels. Demographic and metabolic parameters were analyzed. Multiple logistic regression was performed to analyze the potential predictors for early postpartum dyslipidemia. A receiver operating characteristic curve (ROC) was calculated to determine the cut-off values.

Results: A total of 38.5% of the 589 women developed dyslipidemia in early postpartum and 60% of them had normal glucose metabolism. Delivery age, systolic blood pressure (SBP), glycated hemoglobin (HbA1c) and low-density lipoprotein cholesterol (LDL-C) were independent predictors of early postpartum dyslipidemia in women with a history of GDM. The cut-offs of maternal age, SBP, HbA1c values, and LDL-C levels were 35 years, 123 mmHg, 5.1%, and 3.56 mmol/L, respectively. LDL-C achieved a balanced mix of high sensitivity (63.9%) and specificity (69.2%), with the highest area under the receiver operating characteristic curve (AUC) (0.696). When LDL-C was combined with age, SBP, and HbA1c, the AUC reached to 0.733.

Conclusions: A lipid metabolism evaluation should be recommended in women with a history of GDM after delivery, particularly those with a maternal age > 35 years, SBP > 123 mmHg before labor, HbA1c value > 5.1%, or LDL-C levels > 3.56 mmol/L in the second trimester of pregnancy.

Keywords: Cardiovascular disease; Gestational diabetes mellitus; Lipid, postpartum; Predictor.

Fig. 1

Glucose and lipid metabolism at 6-12 weeks postpartum in women with GDM. a. The incidence of dyslipidemia among normal glucose, prediabetes and diabetes were 35.8, 42.0 and 61.0%, accounted for the whole participants 23.1, 13.6 and 1.89%, respectively. b. The incidence of different type in dyslipidemia. TC = high TC according to the dyslipidemia definition, TG = high TG according to the dyslipidemia definition, HDL-C = high HDL-C according to the dyslipidemia definition, LDL-C = high LDL-C according to the dyslipidemia definition; Mix = high TC and high TG according to the dyslipidemia definition. Single = presented only one type of dyslipidemia accounted for the whole postpartum dyslipidemia

Fig. 2

ROC curves. ROC curves showing the capacity to predict incident dyslipidemia of age, SBP before labor, HbA1c, LDL-C at gestational 24–28 weeks and combined overall. ROC = receiver operating characteristic. AUC = area under the ROC curve. SBP = Systolic blood pressure. LDL-C = low-density lipoprotein cholesterol. Combined = age + SBP + HbA1c + LDL-C