Women withTwin pregnancies and high triglycerides at increased risk of developing gestational diabetes

The researchers reported a strong association between increased triglycerides in the first and second trimesters with gestational diabetes, particularly in older adults, non-overweight, and assisted reproductive technology (ART) groups. Lipid profiles varied among different subtypes of GDM.

In singleton pregnancies, abnormal lipid metabolism is linked with gestational diabetes. There is a lack of data on twin pregnancies with GDM. Kexin Zhang, Capital Medical University, Chaoyang District, Beijing, China, and colleagues explored the association between serum lipid profiles in the first and second trimesters and their dynamic changes and GDM in twin pregnancies in a retrospective cohort study.

The study comprised 2739 twin pregnancies that underwent a 75-g OGTT (oral glucose tolerance test) and were selected from the Beijing Birth Cohort Study from 2013 to 2021. Measurement of low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, and cholesterol at mean 9 and 25 weeks of gestation.

The researchers described maternal lipid levels in different tertiles tied to GDM risk stratified for pre-BMI, age, and fertilization type. GDM patients were categorized into two groups based on OGTT: increased fasting plasma glucose only (FPG group) and the rest of the GDM (non-FPG group). The relative risk of GDM was estimated with multivariable logistic regression models.

The study revealed the following findings:

· 599 (21.9%) twin pregnancies developed gestational diabetes. In univariate analyses, they had increased cholesterol, triglyceride, LDL, and LDL/HDL, decreased HDL levels in the first trimester, increased triglyceride, and decreased HDL in the second trimester.

· In multivariate analysis, when TG > 1.67 mmol/l (upper tertile) in elderly individuals, non-overweight and ART groups increased the risk of GDM by 2.7-fold, 2.3-fold and 2.2-fold, respectively, compared with TG < 0.96 mmol/l (lower tertile). This effect remained in the abovementioned groups in the second trimester.

· High triglycerides increased the risk of GDM in the FPG group (OR = 2.076) and non-FPG group (OR = 2.526) in the first trimester when TG > 1.67 mmol/l and the rising risk in the non-FPG group as the TG tertile increased remained in the second trimester.

· HDL is predominantly negatively associated with elevated FPG in the second trimester.

"Our findings imply the need for Individualized management of dyslipidaemia in twin pregnancies in the first trimester," the researchers concluded.

Reference:

Zhang, K., Zheng, W., Yuan, X. et al. Association between serum lipid profile during the first and second trimester of pregnancy as well as their dynamic changes and gestational diabetes mellitus in twin pregnancies: a retrospective cohort study. Diabetol Metab Syndr 15, 125 (2023). https://doi.org/10.1186/s13098-023-01095-w