Association of lipid metabolism with gestational diabetes mellitus in obese pregnant women
10.3760/cma.j.cn113903-20240821-00583
- VernacularTitle:肥胖孕妇血脂代谢与妊娠期糖尿病的关系
- Author:
Jianxia WEI
1
;
Li ZHOU
1
Author Information
1. 首都医科大学附属北京妇产医院（北京妇幼保健院）产科，北京100026
- Publication Type:Journal Article
- Keywords:
Gestational diabetes mellitus;
Obesity;
Blood lipids
- From:
Chinese Journal of Perinatal Medicine
2025;28(5):353-362
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate risk factors for gestational diabetes mellitus (GDM) and establish early lipid management thresholds in obese pregnant women.Methods:This prospective cohort study enrolled obese women [pre-pregnancy body mass index (BMI)≥28 kg/m2] during their first prenatal visit (6-12 weeks of gestation) at Beijing Obstetrics and Gynecology Hospital, Capital Medical University from October 2021 to October 2022. Serum lipid profiles [total cholesterol, triglycerides (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol] were measured in the first (6-12 weeks), second (24-28 weeks), and third trimesters (34-37 weeks), with body weight tracked at 16, 20, and 24 weeks of gestation. Participants were stratified by pre-pregnancy BMI into mild (≥28-<30 kg/m2), moderate (≥30-<35 kg/m2), and severe obesity (≥35 kg/m2) groups; meanwhile, they were also stratified into GDM and non-GDM groups. Intergroup differences were analyzed using independent t-tests, Wilcoxon and Kruskal-Wallis rank-sum tests, one-way analysis of variance, and Chi-square tests. Binary logistic regression identified independent risk factors for GDM, while a decision tree model incorporating maternal age, pre-pregnancy BMI, first-trimester FBG, lipid levels, and weight gain at 16/20/24 weeks was constructed to delineate GDM risk stratification. Receiver operating characteristic curves established first-trimester lipid thresholds for GDM prevention in mild and moderate obesity subgroups. Results:After excluding 88 cases, 487 women were analyzed, with 202 (41.5%) developing GDM. (1) Weight gain disparities: There were statistically significant differences in weight gain at 16, 20, and 24 weeks of gestation among pregnant women with mild, moderate, and severe pre-pregnancy obesity [at 16 weeks: 1.0 (0.0-3.0), 0.9 (－1.0-2.0) vs.－1.4 (－3.0-1.1) kg, χ 2=16.92; at 20 weeks: 3.0 (1.0-5.0), 2.0 (0.0-4.0) vs.－0.5 (－2.3-1.3) kg, χ 2=23.94; at 24 weeks of gestation: 4.0 (2.0-7.0), 3.0 (1.0-5.0) vs. 0.0 (－2.0-3.1) kg, χ 2=28.27; all P<0.001]. GDM incidence escalated with obesity severity: 36.9% (93/252) in mild, 45.0% (95/211) in moderate, and 58.3% (14/24) in severe obesity groups ( χ2=6.07, P=0.048). No significart difference was found in serum lipid profiles during the first, second, and third trimesters (all P>0.05). (2) Risk factors: First-trimester FBG was the risk factor of GDM in pre-pregnancy obese pregnant women ( OR=5.196, 95% CI: 3.025-8.926, P<0.001). (3) The decision tree model revealed that the key nodes for GDM development in obese pregnant women were first-trimester FBG, first-trimester TG levels, maternal age, first-trimester HDL-C, and pre-pregnancy BMI. When obese pregnant women had FBG≥5.1 mmol/L and age≥35 years, the incidence of GDM reached 88%. Conversely, when first-trimester TG<1.5 mmol/L, first-trimester FBG<4.9 mmol/L, and first trimester HDL-C≥1.3 mmol/L, the GDM incidence dropped to 15%. (4) First-trimester TG thresholds of 1.5 mmol/L for mild obesity (area under the curve was 0.626, 95% CI: 0.556-0.697) and 1.4 mmol/L for moderate obesity (area under the curve was 0.636, 95% CI:0.560-0.713) to guide lipid management. Conclusions:First-trimester FBG is closely associated with GDM development in pre-pregnancy obese women, with varying incidences across different obesity severity levels. Clinical management should prioritize both glycemic control and early-pregnancy lipid monitoring in mild-to-moderately obese populations.
