Brief overview of maternal triglycerides as a risk factor for pre-eclampsia.
BACKGROUND
Features of the metabolic syndrome-maternal obesity, diabetes mellitus and chronic hypertension-are risk factors for pre-eclampsia.


OBJECTIVE
To determine the risk of pre-eclampsia in the presence of maternal hypertriglyceridemia, another major element of the metabolic syndrome.


METHODS
Two investigators independently searched PubMed and Embase databases from 1980 to December 2004 for relevant studies. The terms preeclampsia, eclampsia, pregnancy-induced hypertension or toxemia were combined with dyslipidemia, hyperlipidemia, hypertriglyceridemia, lipids, cholesterol, triglycerides (TG) or lipoprotein.


METHODS
We included case-control and cohort studies published in English that included at least 20 women with pre-eclampsia and that sampled serum or plasma TG at any time before, during or after pregnancy.


METHODS
Mean maternal TG concentrations were compared between cases and controls within each study. The odds ratio of pre-eclampsia was calculated by comparing the risk of pre-eclampsia among women in each higher TG concentration category with that in the lowest reference category.


RESULTS
A total of 19 case-control and 3 prospective cohort studies were included. In 14 studies, the mean TG concentration was significantly higher among pre-eclamptic cases than among unaffected controls; in seven other studies, there was a nonsignificant trend in the same direction. The risk of pre-eclampsia typically doubled with each increasing TG category. In the four studies that adjusted for potential confounders, such as maternal age, parity and body mass index, there was about a four-fold higher risk of pre-eclampsia in the highest relative to the lowest TG category.


CONCLUSIONS
There exists a consistent positive association between elevated maternal TG and the risk of pre-eclampsia. Given that maternal hypertriglyceridemia is a common feature of the metabolic syndrome, interventional studies are needed to determine whether pre-pregnancy weight reduction and dietary modification can lower the risk of pre-eclampsia.
Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. rayj@smh.toronto.on.ca
J G
JG
Ray
P
P
Diamond
G
G
Singh
C M
CM
Bell
D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood / Q000150:complications*; D011225:Pre-Eclampsia / Q000097:blood / Q000209:etiology*; D011247:Pregnancy; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood*
D015415:Biomarkers; D014280:Triglycerides