Chapter 7 - Triglyceride metabolism in pregnancy

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Abstract

During pregnancy, complex changes occur in lipid profiles. From the 12th week of gestation, phospholipids, cholesterol (total, LDL, HDL), and triglycerides (TG) increase in response to estrogen stimulation and insulin resistance. Transition to a catabolic state favors maternal tissue lipid use as energy sources, thus sparing glucose and amino acids for the fetus. In addition, maternal lipids, that is, cholesterol, are available for fetal use in building cell membranes and as precursor of bile

Changes in Maternal Lipid Metabolism

During pregnancy, metabolic changes in the liver and adipose tissue alter circulating TG, fatty acid, cholesterol, and phospholipids. Despite an initial reduction, plasma lipids increase following the first 8 weeks of pregnancy. Increased insulin resistance and estrogen stimulation during pregnancy are responsible for this state of maternal hyperlipidemia [4]. Hyperphagia [5] and increased lipid synthesis [6] contribute to maternal fat accumulation typically associated with the first two-thirds

Gestational Diabetes

Diabetic pregnancy appears associated with significantly increased TG at all gestational stages [44], [45], [46]. Recently, some authors have suggested TG assessment during the first trimester to improve early screening for gestational glucose intolerance [47]. Interestingly, the presence of both maternal abdominal obesity and hypertriglyceridemia in the first trimester was associated with significantly increased risk of glucose intolerance later in pregnancy. Conflicting reports on the role of

Macrosomia

TG are important contributors to fetal growth during pregnancy. Reports clearly link maternal TG concentration during the third trimester to neonatal birth weight. Others have shown a positive correlation between nonfasting serum TG and birth weight in women with GDM independent of prepregnancy BMI [61] and rate of weight gain [39]. We demonstrated a positive correlation between fasting TG concentration and newborn weight independent of glucose concentration and body weight during the third

Changes in Lipids During Pregnancy and Risk of Cardiovascular Disease

During pregnancy, changes in lipid profile may have a role in endothelial damage and activation of atherogenesis (Table 3) [26].

Brizzi et al.[75] investigated the changes in lipoproteins and lipids in women during normal pregnancy and compared their results with those obtained in nulliparous women of similar age. Pregnant women had increased TG, total cholesterol, and LDL cholesterol versus nulliparous women. Multiparous women had higher TG and lower HDL versus primiparous women. They proposed

Lifestyle

Physical activity is effective in preventing GDM, gestational hypertension, and preeclampsia [79], [80], [81]. Only one study, however, evaluated the effect of physical activity on lipids [82]. In this study, lipids were evaluated in 925 normotensive, nondiabetic women at the 13th week of gestation. The participants were queried as to type, frequency, and duration of physical activity during the previous 7 days.

Mean TG were lower in women performing any physical activity. Mean TG and total

Conclusions

Lipid levels, especially TG, increase during pregnancy. Changes in lipid metabolism are mediated by estrogen concentration and insulin resistance. The state of maternal hypertriglyceridemia has many positive effects and contributes to fetal growth and development. Maternal TG serves as a reservoir for dietary fatty acids and as a “floating” energy depot.

Despite these benefits, increased maternal TG appear involved in development of preeclampsia and contributes to preterm birth. In addition, LGA

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