Association of maternal HDL2-c concentration in the first trimester and the risk of large for gestational age birth

Abstract

Background: Maternal lipid levels during pregnancy are critical for fetal development. Recent studies revealed that high-density lipoprotein cholesterol (HDL-c) levels during pregnancy were negatively correlated with birthweight. High-density lipoprotein 2 cholesterol (HDL2-c) is one of the major subclasses of HDL-c, and its relationship with birthweight is unclear. Association of HDL2-c concentration in the first trimester and risk of large for gestational age (LGA) was explored.

Methods: This study recruited pregnant women who registered in Fuxing Hospital from October 2018 to January 2020, had regular obstetric examinations during pregnancy, and delivered between June 2019 and September 2020. Finally, 549 participants were recruited for the study. Maternal demographic characteristics and venous blood were collected at the 6th-14th gestational week, and serum total cholesterol (TC), triglyceride (TG), HDL-c, HDL2-c, high-density lipoprotein 3 cholesterol (HDL3-c), and low-density lipoprotein cholesterol (LDL-c) concentrations were detected. Neonatal characteristics were collected at delivery. A logistic regression model was used to explore the relationship between the first trimester HDL2-c concentration and LGA incidence. A nomogram was developed, and the performance was evaluated with a concordance index.

Results: Seventy-five mothers delivered LGA infants, and the LGA incidence was 13.66%. LGA mothers had significantly lower serum HDL-c and HDL2-c concentrations than appropriate for gestational age (AGA) mothers. A logistic regression model showed that HDL2-c concentration was negatively correlated with LGA risk (odds ratio (OR) = 0.237, 95% confidence intervals (CI): 0.099-0.567, P = 0.001) when adjusted for age, prepregnancy body mass index (BMI), and parity. A nomogram was generated using all these risk factors. The area under the curve (AUC) was 0.663 (95% CI: 0.593-0.732).

Conclusions: Maternal HDL2-c concentration in the first trimester was negatively correlated with the risk of LGA.

Keywords: Birthweight; HDL; HDL subfractions; LGA; Maternal lipids.

Fig. 1

Maternal serum HDL-c, HDL2-c, and HDL3-c concentrations and HDL2-c/HDL3-c ratios in the first trimester in the AGA and LGA groups. a Maternal serum HDL-c, HDL2-c, and HDL3-c concentrations in the first trimester in the AGA and LGA groups. b The ratio of HDL2-c/HDL3-c in the AGA and LGA groups. AGA, appropriate for gestational age. LGA, large for gestational age. *P < 0.05, **P < 0.01

Fig. 2

The incidence of LGA based on different maternal HDL-c, HDL2-c, and HDL3-c concentrations and HDL2-c/HDL3-c ratios in the first trimester. a The incidence of LGA based on different maternal HDL-c concentrations in the first trimester. b The incidence of LGA based on different maternal HDL2-c concentrations in the first trimester. c The incidence of LGA based on different maternal HDL3-c concentrations in the first trimester. d The incidence of LGA based on different maternal ratios of HDL2-c/HDL3-c in the first trimester. LGA, large for gestational age. AGA, appropriate for gestational age. *P value < 0.05, **P value < 0.01

Fig. 3

Nomogram for the risk of LGA. To estimate the probability of LGA, the values of a pregnant woman value were marked at each axis. A straight line was drawn perpendicular to the point axis, and the points for all variables were summed. Next, the sum was noted on the total point axis, and a straight line was drawn perpendicular to the probability axis. LGA, large for gestational age. GWG, gestational weight gain. BMI, body mass index

Fig. 4

Receiver operating characteristic curve for the prediction model. The area under the curve (AUC) was 0.663 (95% CI 0.593–0.732)