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. 2025 Apr 8:16:1545393.
doi: 10.3389/fendo.2025.1545393. eCollection 2025.

Influence of maternal lipid levels on adverse pregnancy outcomes in women with gestational diabetes mellitus

Ru Zhao  1   2 , Jun Hu  3 , Yuanqin Li  1   2 , Xuetao Chen  1   2 , Qian Wang  1   2 , Tingting Wu  1   2 , Weihong Zhou  4 , Yan Bi  1   2 , Shanmei Shen  1   2 , Zhijuan Ge  1   2
Affiliations

Influence of maternal lipid levels on adverse pregnancy outcomes in women with gestational diabetes mellitus

Ru Zhao et al. Front Endocrinol (Lausanne). .

Abstract

Objective: This study aimed to investigate the effect of mid-pregnancy lipid levels on adverse outcomes in women with gestational diabetes mellitus (GDM) under adequate glycemic control. Whether this effect is independent of factors such as blood glucose was also analyzed.

Methods: We retrospectively analyzed 1,001 women with normal glucose tolerance (NGT) and 1,078 women with GDM under adequate glycemic control from 2015 to 2024. Logistic regression analysis was used to explore the relationship between blood lipids and adverse outcomes. Those with GDM were further classified according to their pre-pregnancy body mass index (BMI), gestational weight gain, glycosylated hemoglobin A1c (HbA1c), and fasting blood glucose (FBG). An interaction model between triglyceride (TG) and pre-pregnancy BMI, gestational weight gain, HbA1c, and FBG on adverse outcomes was constructed.

Results: In GDM, high levels of TG were independent risk factors for preeclampsia (OR = 1.51, 95%CI = 1.18-1.93), preterm birth (OR = 1.68, 95%CI = 1.30-2.18), macrosomia (OR = 1.48, 95%CI = 1.14-1.92), postpartum hemorrhage (OR = 1.33, 95%CI = 1.10-1.61), and intrauterine fetal distress (OR = 1.68, 95%CI = 1.13-2.51). Furthermore, TG had a greater impact on GDM women than on NGT women. In addition, in GDM, high levels of TG were independent risk factors for the above adverse outcomes in the subgroups of pre-pregnancy BMI, gestational weight gain, HbA1c, and FBG (interaction p > 0.05).

Conclusions: High levels of TG promoted the occurrence of preeclampsia, preterm birth, macrosomia, postpartum hemorrhage, and intrauterine fetal distress in women with GDM. Furthermore, TG had a greater effect on adverse outcomes in GDM than in NGT women.

Keywords: adverse outcomes; gestational diabetes mellitus; lipids; pregnancy; risk factors.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Pearson’s correlation analysis between triglyceride (TG) and various other factors in women with gestational diabetes mellitus (GDM). (A) Scatter plot of TG and gestational weight gain. TG was significantly negatively correlated with gestational weight gain (R = −0.089, p = 0.001). (B) Scatter plot of TG and pre-pregnancy BMI. TG was significantly positively correlated with pre-pregnancy BMI (R = 0.273, p < 0.001). (C) Scatter plot of TG and HbA1c. TG was significantly positively correlated with HbA1c (R = 0.140, p < 0.001). (D) Scatter plot of TG and FBG. TG was significantly positively correlated with FBG (R = 0.186, p < 0.001). R, relevant coefficients; BMI, body mass index; FBG, fasting blood glucose; HbA1c, glycosylated hemoglobin A1c.
Figure 2
Figure 2
Analysis of the interaction between triglyceride (TG) and various factors in gestational diabetes mellitus (GDM) women. (1, 2) Analysis of the interaction between TG and various other factors in women with GDM. Adjusted odds ratios were adjusted for pre-pregnancy BMI, gestational weight gain, and FBG. The p-value for interaction was >0.05. There was no significant distinction in the impact of TG on adverse pregnancy outcomes between individuals with different levels of pre-pregnancy BMI (<24 or ≥24 kg/m2), gestational weight gain (appropriate or inappropriate), HbA1c (<5.2% or ≥5.2%), and FBG (<5.1 or ≥5.1 mmol/L). BMI, body mass index; FBG, fasting blood glucose; HbA1c, glycosylated hemoglobin A1c.
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