Changes in lipid profile after treatment of women with gestational diabetes mellitus

- The prevalence of GDM is rising and controversy still exists on how GDM treatment may affect lipoprotein concentrations.
- Total cholesterol and triglycerides levels increased after 3 to 6 weeks of GDM treatment initiation, decreasing at postpartum.
- LDL levels remained stable and levels only changed postpartum.
- Insulin requirement and glycemic control status, but not BMI at diagnosis, directly affected the alterations of lipid profile in women with GDM.

BackgroundInsulin 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.ObjectiveTo 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.MethodsIn 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.ResultsTC 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.ConclusionsInsulin requirement and glycemic control status directly affected the variation of lipid profile in women with GDM.