Predictors of Postpartum Lipid Abnormalities in Women with Gestational Diabetes

Objective: Pregnancy-related changes in serum lipids are well documented, but the predictors of post-pregnancy dyslipidemia are not as well delineated. We assessed potential pre- and intrapartum predictors in women with gestational diabetes mellitus (GDM). Method: Among women followed at a university-based GDM clinic (Montreal, Canada), we identified those with intra-and postpartum lipid values (routine assessments) between January 1, 2007 and December 31, 2008. Dyslipidemia was defined as total cholesterol/high-density lipoprotein (TC/HDL) >= 4.0. Potential predictors of postpartum dyslipidemia assessed through logistic regression included increased intrapartum triglycerides (>= 2.5 mmol/L), intrapartum dyslipidemia, age, gravida, type 2 diabetes family history, ethnicity, prepregnancy body mass index (BMI), intrapartum insulin resistance (HOMA-IR) and systolic blood pressure. Results: Among 46 subjects, 50% had postpartum dyslipidemia. Prepregnancy BMI (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.2-2.5), intrapartum HOMA-IR (OR 2.3, 95% CI 1.0-5.6), and systolic blood pressure (OR 1.1, 95% CI 1.0-1.2) were all independent predictors. Intrapartum triglycerides (OR 3.0, 95% CI 0.8-11.1) and TC/HDL (OR 1.8, 95% CI 0.7-4.5) were potential predictors but results were inconclusive (models adjusted for prepartum BMI, intrapartum HOMA-IR, systolic blood pressure). Conclusions: Higher prepregnancy BMI, greater degree of intrapartum insulin resistance and higher systolic blood pressure independently predict postpartum dyslipidemia among women with GDM who presented for postpartum reassessment. Women with these characteristics may require closer surveillance and attention to vascular disease prevention efforts. Our results also support the possibility that intrapartum lipid levels in women with a GDM history may predict postpartum values, but a larger study is needed to confirm this possibility conclusively. (C) 2012 Canadian Diabetes Association