(Reuters Health) - Women with high lipid levels during early pregnancy are at increased risk for having offspring with congenital heart disease, a new study suggests.
Researchers examined data on blood lipid levels during pregnancy for 230 women whose children had congenital heart disease and 381 women whose children without this birth defect. All the women had fasting blood draws during their first prenatal visit, between 8 and 14 weeks gestation.
Women were significantly more likely to have a child with congenital heart disease when these first trimester blood tests showed high triglycerides (adjusted odds ratio 2.46), high total/HDL-cholesterol (aOR 2.10), and high apolipoprotein-A1 (aOR 2.73). The analysis adjusted for age, body mass index, parity, gestational week, sex of the child, multiple birth, HbA1c, vitamin B12, folic acid, and homocysteine.
"Certainly, individuals with elevated lipids have higher risks of diabetes as well, so it may simply be that it isn't the lipids themselves, but rather their association with diabetes and maternal hyperglycemia," said Dr. Aaron Caughey, a professor and chair of Obstetrics and Gynecology at Oregon Health & Science University in Portland, who wasn't involved in the study.
"We know both from epidemiology and animal models that maternal hyperglycemia is strongly associated with congenital anomalies specifically including cardiac anomalies," Dr. Caughey said by email.
Lipids in pregnancy have been understudied, however, so larger epidemiologic studies are needed as are basic causal studies to elucidate a mechanism between maternal lipids and their potential for disruption in development of the developing fetus, Dr. Caughey added.
Senior study author Yong-Hao Gui of the Children's Hospital of Fudan University in Shanghai, China, didn't respond to emails seeking comment.
There were no significant differences between fasting glucose and HbA1c between the mothers who had children with congenital heart defects and the mothers who didn't, nor was there a difference in folate levels, the study team reports in Acta Obstetricia et Gynecologica Scandinavica.
The study also didn't find an association between maternal lipid levels and the severity of congenital heart disease.
The most common type of congenital heart disease was ventricular septal defects, accounting for 44.2% of cases, followed by pulmonary stenosis with 8.5% of cases, and tetralogy of Fallot with 5.4% of cases.
Multiple births were more common in the congenital heart disease group (13%) than in the control group of mothers (0.5%).
Gestational diabetes was also more common in the congenital heart disease group (14.8%) than in the control group (5.5%).
Pregnancy facilitated by IVF or other forms of ART was also more common in the congenital heart disease group (16.5%) than in the control group (3.1%).
One limitation of the study is that it was based on data from a single center, and that it used claims data, which don't include detailed clinical information on individual patients.
The study was also underpowered to determine the impact of maternal lipid levels on subtypes of congenital heart disease.
"It is possible that lipid metabolism in early pregnancy may influence the outcome of pregnancy," the study team concluded. "However, this association needs to be further investigated by large prospective studies as well as mechanistic studies to establish its causality."
SOURCE: https://bit.ly/3kXlihg Acta Obstetricia et Gynecologica Scandinavica, online August 3, 2021.
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