Normalizing metabolism in diabetic pregnancy: is it time to target lipids?
Outcomes in pregnancies complicated by preexisting diabetes (type 1 and type 2) and gestational diabetes mellitus have improved, but there is still excess morbidity compared with normal pregnancy. Management strategies appropriately focus on maternal glycemia, which demonstrably improves pregnancy outcomes for mother and infant. However, we may be reaching the boundaries of obtainable glycemic control for many women. It has been acknowledged that maternal lipids are important in pregnancies complicated by diabetes. Elevated maternal lipids are associated with preeclampsia, preterm delivery, and large-for-gestational-age infants. Despite this understanding, assessment of management strategies targeting maternal lipids has been neglected to date. Consideration needs to be given to whether normalizing maternal lipids would further improve pregnancy outcomes. This review examines the dyslipidemia associated with pregnancy complicated by diabetes, reviews possible therapies, and considers whether it is time to start actively managing this aspect of maternal metabolism.
Corresponding author: Helen L. Barrett, h.barrett@uq.edu.au.
Helen L
HL
Barrett
Marloes
M
Dekker Nitert
H David
HD
McIntyre
Leonie K
LK
Callaway
D000328:Adult; D001786:Blood Glucose / Q000187:drug effects*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D016640:Diabetes, Gestational / Q000188:drug therapy* / Q000378:metabolism; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005865:Gestational Age; D006801:Humans; D006953:Hyperlipoproteinemia Type IV / Q000150:complications / Q000188:drug therapy; D007231:Infant, Newborn; D050356:Lipid Metabolism / Q000187:drug effects; D008074:Lipoproteins / Q000378:metabolism; D008431:Maternal-Fetal Exchange; D009765:Obesity / Q000150:complications; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000188:drug therapy* / Q000378:metabolism
D001786:Blood Glucose; D008074:Lipoproteins