Vivian Nunes Kern Pessôa1, Melanie Rodacki2, Carlos Antonio Negrato3, Lenita Zajdenverg2. 1. Internal Medicine Department, Diabetes Section-Federal University of Rio de Janeiro, Brazil. Electronic address: vnkern@gmail.com. 2. Internal Medicine Department, Diabetes Section-Federal University of Rio de Janeiro, Brazil. 3. Bauru's Diabetics Association, Bauru, São Paulo, Brazil.
Abstract
BACKGROUND: Insulin resistance, a key factor in the pathophysiology of gestational diabetes mellitus (GDM), is associated with an atherogenic lipid profile. Lipid metabolism is altered during normal pregnancy, but it is still unknown how the treatment of GDM affects lipoprotein concentrations. OBJECTIVE: To evaluate maternal lipids at GDM diagnosis, after treatment, and in the puerperium and analyze the influence of BMI, insulin requirement, and glycemic control on lipoproteins. METHODS: In this observational prospective study, total cholesterol (TC), HDL, and triglycerides (TG) were measured, and LDL was calculated at diagnosis (Dx), at 3-6 weeks after GDM treatment initiation (PI, post initiation) and 6-week postpartum (PP). Subgroups analyses were performed according to categories of maternal BMI, insulin requirement, and quality of glucose control. RESULTS: TC and TG increased from Dx to PI and decreased in PP (TC: 213.6 mg/dL, 223.9 mg/dL, and 195.5 mg/dL; TG: 181.5 mg/dL, 203.5 mg/dL, and 100.5 mg/dL, at Dx, PI, and PP, respectively; P < .0001). HDL declined in the puerperium (Dx = 60 mg/dL, PI = 60.8 mg/dL, PP = 51.8 mg/dL; P < .0001 for Dx-PP and PI-PP, respectively). Insulin-treated patients showed an increase in LDL from Dx to PP, whereas LDL declined in the diet-only group (12 vs -11.1 mg/dL, P = .010). TC and TG increased from Dx to PI in patients with adequate glycemic control and decreased in the uncontrolled subgroup (TC: 15.5 vs -1.2 mg/dL, P = .041; TG: 29.7 vs -12.5 mg/dL, P = .07). No significant differences in lipids variation were observed according to BMI. CONCLUSIONS: Insulin requirement and glycemic control status directly affected the variation of lipid profile in women with GDM.
BACKGROUND:Insulin resistance, a key factor in the pathophysiology of gestational diabetes mellitus (GDM), is associated with an atherogenic lipid profile. Lipid metabolism is altered during normal pregnancy, but it is still unknown how the treatment of GDM affects lipoprotein concentrations. OBJECTIVE: To evaluate maternal lipids at GDM diagnosis, after treatment, and in the puerperium and analyze the influence of BMI, insulin requirement, and glycemic control on lipoproteins. METHODS: In this observational prospective study, total cholesterol (TC), HDL, and triglycerides (TG) were measured, and LDL was calculated at diagnosis (Dx), at 3-6 weeks after GDM treatment initiation (PI, post initiation) and 6-week postpartum (PP). Subgroups analyses were performed according to categories of maternal BMI, insulin requirement, and quality of glucose control. RESULTS:TC and TG increased from Dx to PI and decreased in PP (TC: 213.6 mg/dL, 223.9 mg/dL, and 195.5 mg/dL; TG: 181.5 mg/dL, 203.5 mg/dL, and 100.5 mg/dL, at Dx, PI, and PP, respectively; P < .0001). HDL declined in the puerperium (Dx = 60 mg/dL, PI = 60.8 mg/dL, PP = 51.8 mg/dL; P < .0001 for Dx-PP and PI-PP, respectively). Insulin-treated patients showed an increase in LDL from Dx to PP, whereas LDL declined in the diet-only group (12 vs -11.1 mg/dL, P = .010). TC and TG increased from Dx to PI in patients with adequate glycemic control and decreased in the uncontrolled subgroup (TC: 15.5 vs -1.2 mg/dL, P = .041; TG: 29.7 vs -12.5 mg/dL, P = .07). No significant differences in lipids variation were observed according to BMI. CONCLUSIONS:Insulin requirement and glycemic control status directly affected the variation of lipid profile in women with GDM.