The graded relationship between glucose tolerance status in pregnancy and postpartum levels of low-density-lipoprotein cholesterol and apolipoprotein B in young women: implications for future cardiovascular risk.
OBJECTIVE
Both gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT) identify women at risk of future cardiovascular disease, although the mediators of this risk are unknown. Because lipid factors can contribute to cardiovascular risk, we sought to characterize the relationship between gestational glucose tolerance status and lipid profile in pregnancy and the postpartum.


METHODS
Fasting lipids were measured in 482 women in pregnancy and at 3 months postpartum. Antepartum glucose challenge test (GCT) and oral glucose tolerance test (OGTT) defined four gestational glucose tolerance groups: GDM (n = 136), GIGT (n = 89), abnormal GCT with normal glucose tolerance (NGT) on OGTT (abnormal GCT NGT) (n = 170), and normal GCT with NGT on OGTT (normal GCT NGT) (n = 87).


RESULTS
In pregnancy, there were no significant differences between the groups in total and low-density lipoprotein (LDL) cholesterol, triglycerides, total cholesterol to high-density lipoprotein (HDL) cholesterol ratio, apolipoprotein B (apoB), apolipoprotein A1 (apoA1), and apoB to apoA1 ratio. At 3 months postpartum, however, each of the following lipid parameters progressively increased from normal GCT NGT to abnormal GCT NGT to GIGT to GDM: total cholesterol (P = 0.0047), LDL (P = 0.0002), triglycerides (P = 0.0002), total cholesterol to HDL ratio (P < 0.0001), apoB (P = 0.0003), and apoB to apoA1 ratio (P = 0.0014). Furthermore, on multiple linear regression analyses, GDM emerged as an independent predictor of postpartum total cholesterol (t = 3.09, P = 0.0021), LDL (t = 3.81, P = 0.0002), triglycerides (t = 3.38, P = 0.0008), total cholesterol to HDL ratio (t = 3.76,P = 0.0002), apoB (t = 4.12, P < 0.0001), and apoB to apoA1 ratio (t = 3.07, P = 0.0023). GIGT was an independent predictor of postpartum total cholesterol to HDL ratio (t = 2.27, P = 0.0239), apoB (t = 2.04, P = 0.0416), and apoB to apoA1 ratio (t = 1.97, P = 0.049).


CONCLUSIONS
Compared with their peers, women with GDM and GIGT have a more atherogenic lipid profile by 3 months postpartum, characterized by increased LDL and apoB.
Retnakaran
Ravi
R
Leadership Sinai Centre for Diabetes, 60 Murray Street, Suite L5-039, Mailbox 21, Toronto, Ontario, Canada M5T 3L9. rretnakaran@mtsinai.on.ca
Qi
Ying
Y
Connelly
Philip W
PW
Sermer
Mathew
M
Hanley
Anthony J
AJ
Zinman
Bernard
B
D000328:Adult; D001055:Apolipoproteins B / Q000097:blood*; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D016022:Case-Control Studies; D008078:Cholesterol, LDL / Q000097:blood*; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis / Q000378:metabolism; D005260:Female; D018149:Glucose Intolerance / Q000097:blood / Q000150:complications / Q000175:diagnosis; D005951:Glucose Tolerance Test; D006304:Health Status; D006801:Humans; D049590:Postpartum Period / Q000097:blood*; D011247:Pregnancy / Q000097:blood* / Q000378:metabolism; D011248:Pregnancy Complications / Q000097:blood / Q000175:diagnosis / Q000378:metabolism; D011379:Prognosis; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors
D001055:Apolipoproteins B; D001786:Blood Glucose; D008078:Cholesterol, LDL