The Association between Dyslipidemia and Preterm Birth: A Prospective Cohort Study in The North of Iran

Author(s): Seyedeh H. Sharami, Mahboobeh Gholipour, Forozan Milani, Ehsan Kazemnejad, Seyedeh F.D. Heirati, Zahra A. Ranjbar*

Journal Name: Endocrine, Metabolic & Immune Disorders - Drug Targets
(Formerly Current Drug Targets - Immune, Endocrine & Metabolic Disorders)

Volume 20 , Issue 2 , 2020

Become EABM
Become Reviewer

Graphical Abstract:


Background: Dyslipidemia is recognized as an important factor in the incidence of Preterm Birth (PTB). The early diagnosis of factors affecting PTB is important in the reduction of maternalneonatal complications; therefore, we aimed to evaluate the association between dyslipidemia and PTB in women from the Guilan province of Iran.

Methods: The current investigation was a prospective cohort study on 378 pregnant women in Rasht city (Guilan province), during 2018-2019. Samples were randomly selected among pregnant women who referred to Al-Zahra hospital. Association of the lipid profiles: Total Cholesterol (TC), High- Density Lipoprotein (HDLC), Low-Density Lipoprotein (LDLC), and Triglycerides (TG) with PTB was assessed using the Chi-square, Fisher tests and logistic regression analysis.

Results: Our findings showed that of the evaluated lipid profiles, TG and TC had the highest predictive power with AUC =0.833 (95٪, CI: 0.736-0.930) and 0.772 (95%, CI: 0.676-0.867), respectively; also, their sensitivity and specificity were 83.3%, 70.2% and 83.3%, 66.1%, respectively. Moreover, abnormal LDL concentrations increase the risk of PTB by two folds (P < 0.05).

Conclusion: It seems that by controlling the lipid profiles of pregnant women, the risk of PTB could be reduced.

Keywords: Dyslipidemia, preterm birth, women, pregnancy, triglycerides, Iran, prospective cohort study.

Cunningham, F; Leveno, K; Bloom, S; Spong, CY Dashe, J Williams obstetrics, 24e: Mcgraw-hill. 2014.
Williams3 obestericts. In: Gary guunigham, F.; Kenneth, J.; Houth, J.; Spong, G., Eds.; Mc Graw Hill, 2018.
Howson, C.P.; Kinney, M.V.; McDougall, L.; Lawn, J.E. Born too soon: preterm birth matters. Reprod. Health, 2013, 10(1)(Suppl. 1), S1.
[] [PMID: 24625113]
Beck, S.; Wojdyla, D.; Say, L.; Betran, A.P.; Merialdi, M.; Requejo, J.H.; Rubens, C.; Menon, R.; Van Look, P.F. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull. World Health Organ., 2010, 88(1), 31-38.
[] [PMID: 20428351]
Martin, R.J.; Fanaroff, A.A. Walsh, MC Fanaroff and Martin’s Neonatal-Perinatal Medicine E-Book: Diseases of the Fetus and Infant; Elsevier Health Sciences, 2010.
Piechota, W.; Staszewski, A. Reference ranges of lipids and apolipoproteins in pregnancy. Eur. J. Obstet. Gynecol. Reprod. Biol., 1992, 45(1), 27-35.
[] [PMID: 1618359]
Butte, N.F. Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus. Am. J. Clin. Nutr., 2000, 71(5)(Suppl.), 1256S-1261S.
[] [PMID: 10799399]
Brizzi, P.; Tonolo, G.; Esposito, F.; Puddu, L.; Dessole, S.; Maioli, M.; Milia, S. Lipoprotein metabolism during normal pregnancy. Am. J. Obstet. Gynecol., 1999, 181(2), 430-434.
[] [PMID: 10454696]
Wiznitzer, A.; Mayer, A.; Novack, V.; Sheiner, E.; Gilutz, H.; Malhotra, A.; Novack, L. Association of lipid levels during gestation with preeclampsia and gestational diabetes mellitus: a population-based study. Am. J. Obstet. Gynecol., 2009, 201(5), 482.e1-482.e8.
[] [PMID: 19631920]
An-Na, C.; Man-Li, Y.; Jeng-Hsiu, H.; Pesus, C.; Shin-Kuo, S. Alterations of serum lipid levels and their biological relevances during and after pregnancy. Heung-Tat NJLs., 56(26), 2367-2375. 1995.
Chiang, A.N.; Yang, M.L.; Hung, J.H.; Chou, P.; Shyn, S.K.; Ng, H.T. Alterations of serum lipid levels and their biological relevances during and after pregnancy. Life Sci., 1995, 56(26), 2367-2375.
[] [PMID: 7791523]
Potter, J.M.; Nestel, P.J. The hyperlipidemia of pregnancy in normal and complicated pregnancies. Am. J. Obstet. Gynecol., 1979, 133(2), 165-170.
[] [PMID: 217273]
Brizzi, P; Tonolo, G; Esposito, F; Puddu, L; Dessole, S; Maioli, M Lipoprotein metabolism during normal pregnancy. 181(2), 430- 434.1999.
Wahabi, H.A.; Fayed, A.A.; Alzeidan, R.A.; Mandil, A.A. The independent effects of maternal obesity and gestational diabetes on the pregnancy outcomes. BMC Endocr. Disord., 2014, 14(1), 47.
[] [PMID: 24923207]
Velayati, A; Nouruzi, E Nelson textbook of pediatrics. Tehran: Andishe rafee, 2016.
Roberts, D.; Brown, J.; Medley, N.; Dalziel, S.R. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane database of systematic reviews, 32017,
Kushtagi, P.; Arvapally, S. Maternal mid-pregnancy serum triglyceride levels and neonatal birth weight. Int. J. Gynaecol. Obstet., 2009, 106(3), 258-259.
[] [PMID: 19327771]
Vrijkotte, T.G.; Krukziener, N.; Hutten, B.A.; Vollebregt, K.C.; van Eijsden, M.; Twickler, M.B. Maternal lipid profile during early pregnancy and pregnancy complications and outcomes: the ABCD study. J. Clin. Endocrinol. Metab., 2012, 97(11), 3917-3925.
[] [PMID: 22933545]
Ying, C.; Yue, C.; Zhang, C.; Li, X. [Analysis of serum lipids levels and the establishment of reference intervals for serum lipids in middle and late pregnancy Zhonghua Fu Chan Ke Za Zhi, 2015, 50(12), 926-930.
[PMID: 26887877]
Catov, J.M.; Ness, R.B.; Wellons, M.F.; Jacobs, D.R.; Roberts, J.M.; Gunderson, E.P. Prepregnancy lipids related to preterm birth risk: the coronary artery risk development in young adults study. J. Clin. Endocrinol. Metab., 2010, 95(8), 3711-3718.
[] [PMID: 20501685]
Catov, J.M.; Bodnar, L.M.; Ness, R.B.; Barron, S.J.; Roberts, J.M. Inflammation and dyslipidemia related to risk of spontaneous preterm birth. Am. J. Epidemiol., 2007, 166(11), 1312-1319.
[] [PMID: 17906337]
Catov, J.M.; Bodnar, L.M.; Kip, K.E.; Hubel, C.; Ness, R.B.; Harger, G.; Roberts, J.M. Early pregnancy lipid concentrations and spontaneous preterm birth. Am. J. Obstet. Gynecol., 2007, 197(6), 610.e1-610.e7.
[] [PMID: 18060950]
Edison, R.J.; Berg, K.; Remaley, A.; Kelley, R.; Rotimi, C.; Stevenson, R.E.; Muenke, M. Adverse birth outcome among mothers with low serum cholesterol. Pediatrics, 2007, 120(4), 723-733.
[] [PMID: 17908758]
Chen, X.; Scholl, T.O. Association of elevated free fatty acids during late pregnancy with preterm delivery. Obstet. Gynecol., 2008, 112(2 Pt 1), 297-303.
[] [PMID: 18669726]
Steffen, KM; Cooper, ME; Shi, M; Caprau, D; Simhan, HN; Dagle, JM Maternal and fetal variation in genes of cholesterol metabolism is associated with preterm delivery. Journal of perinatology : official journal of the California Perinatal Association.,, 27(11), 672- 680.2007.
Jelliffe-Pawlowski, L.L.; Ryckman, K.K.; Bedell, B.; O’Brodovich, H.M.; Gould, J.B.; Lyell, D.J.; Borowski, K.S.; Shaw, G.M.; Murray, J.C.; Stevenson, D.K. Combined elevated midpregnancy tumor necrosis factor alpha and hyperlipidemia in pregnancies resulting in early preterm birth. Am. J. Obstet. Gynecol., 2014, 211(2), 141.e1-141.e9.
[] [PMID: 24831886]
Peltier, M.R. Immunology of term and preterm labor. Reprod. Biol. Endocrinol., 2003, 1, 122.
[] [PMID: 14651749]
Gravett, M.G.; Adams, K.M.; Sadowsky, D.W.; Grosvenor, A.R.; Witkin, S.S.; Axthelm, M.K.; Novy, M.J. Immunomodulators plus antibiotics delay preterm delivery after experimental intraamniotic infection in a nonhuman primate model. Am. J. Obstet. Gynecol., 2007, 197(5), 518.e1-518.e8.
[] [PMID: 17980193]
Grigsby, P.L.; Hirst, J.J.; Scheerlinck, J.P.; Phillips, D.J.; Jenkin, G. Fetal responses to maternal and intra-amniotic lipopolysaccharide administration in sheep. Biol. Reprod., 2003, 68(5), 1695-1702.
[] [PMID: 12606477]
Renaud, SJ; Cotechini, T; Quirt, JS; Macdonald-Goodfellow, SK; Othman, M; Graham, CH Spontaneous pregnancy loss mediated by abnormal maternal inflammation in rats is linked to deficient uteroplacental perfusion. Journal of immunology (Baltimore, Md : 1950), 2011, 186(3), 1799-1808.
Aye, I.L.; Lager, S.; Ramirez, V.I.; Gaccioli, F.; Dudley, D.J.; Jansson, T.; Powell, T.L. Increasing maternal body mass index is associated with systemic inflammation in the mother and the activation of distinct placental inflammatory pathways. Biol. Reprod., 2014, 90(6), 129.
[] [PMID: 24759787]
Germain, A.M.; Carvajal, J.; Sanchez, M.; Valenzuela, G.J.; Tsunekawa, H.; Chuaqui, B. Preterm labor: placental pathology and clinical correlation. Obstet. Gynecol., 1999, 94(2), 284-289.
[] [PMID: 10432144]
Seidman, D.S.; Slater, P.E.; Ever-Hadani, P.; Gale, R. Accuracy of mothers’ recall of birthweight and gestational age. Br. J. Obstet. Gynaecol., 1987, 94(8), 731-735.
[] [PMID: 3663531]
Reece, M.S.; McGregor, J.A.; Allen, K.G.; Harris, M.A. Maternal and perinatal long-chain fatty acids: possible roles in preterm birth. Am. J. Obstet. Gynecol., 1997, 176(4), 907-914.
[] [PMID: 9125620]
Lockwood, C.J.; Kuczynski, E. Markers of risk for preterm delivery. J. Perinat. Med., 1999, 27(1), 5-20.
[] [PMID: 10343929]
Berghaus, T.M.; Demmelmair, H.; Koletzko, B. Fatty acid composition of lipid classes in maternal and cord plasma at birth. Eur. J. Pediatr., 1998, 157(9), 763-768.
[] [PMID: 9776538]
Woollett, L.A. Maternal cholesterol in fetal development: transport of cholesterol from the maternal to the fetal circulation. Am. J. Clin. Nutr., 2005, 82(6), 1155-1161.
[] [PMID: 16332646]
Herrera, E. Lipid metabolism in pregnancy and its consequences in the fetus and newborn. Endocrine, 2002, 19(1), 43-55.
[] [PMID: 12583601]
Schaaf, J.M.; Liem, S.M.; Mol, B.W.; Abu-Hanna, A.; Ravelli, A.C. Ethnic and racial disparities in the risk of preterm birth: a systematic review and meta-analysis. Am. J. Perinatol., 2013, 30(6), 433-450.
[PMID: 23059494]
Ying, C.; Yue, C.; Zhang, C.; Li, X. [Analysis of serum lipids levels and the establishment of reference intervals for serum lipids in middle and late pregnancy]. Zhonghua Fu Chan Ke Za Zhi, 2015, 50(12), 926-930.[Analysis of serum lipids levels and the establishment of reference intervals for serum lipids in middle and late pregnancy].
[PMID: 26887877]

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2020
Page: [227 - 233]
Pages: 7
DOI: 10.2174/1871530319666190529090517
Price: $65

Article Metrics

PDF: 16