GESTATIONAL diabetes mellitus (GDM) affects a significant proportion of pregnancies and, even with appropriate glycaemic control, can lead to adverse maternal and neonatal outcomes. While blood glucose is a known contributor, recent research has turned attention to the potential role of lipid levels during pregnancy. A recent study explored the independent impact of mid-pregnancy triglyceride (TG) levels on adverse outcomes in women with well-controlled GDM, revealing a notable link between elevated TG and increased obstetric risk.
Researchers conducted a retrospective analysis of 2,079 pregnant women receiving antenatal care between 2015 and 2024. The cohort included 1,078 women diagnosed with GDM under adequate glycaemic control and 1,001 women with normal glucose tolerance (NGT). Logistic regression was used to determine the association between lipid levels and adverse outcomes. The GDM group was further stratified by pre-pregnancy BMI, gestational weight gain, HbA1c, and fasting blood glucose (FBG). Interaction models were applied to assess whether the relationship between TG levels and outcomes varied across these subgroups.
The findings demonstrated that high TG levels were significantly associated with a range of adverse outcomes in the GDM group, including preeclampsia (odds ratio [OR] 1.51; 95% CI: 1.18–1.93), preterm birth (OR 1.68; 95% CI: 1.30–2.18), macrosomia (OR 1.48; 95% CI: 1.14–1.92), postpartum haemorrhage (OR 1.33; 95% CI: 1.10–1.61), and intrauterine foetal distress (OR 1.68; 95% CI: 1.13–2.51). These associations remained consistent across all analysed subgroups, with no significant interactions found (p>0.05), indicating that elevated TG levels are an independent risk factor, regardless of BMI, gestational weight gain, HbA1c, or FBG. Notably, the detrimental effect of TG was more pronounced in women with GDM than in those with NGT.
These findings suggest that triglyceride monitoring may offer valuable insight into risk stratification for women with GDM, even when glycaemic targets are met. The study highlights the need to broaden the focus of GDM management to include lipid regulation. However, as a retrospective study, causality cannot be confirmed, and residual confounding may exist. Prospective research is warranted to determine whether interventions targeting lipid levels could improve outcomes in clinical practice.
Reference
Zhao R et al. Influence of maternal lipid levels on adverse pregnancy outcomes in women with gestational diabetes mellitus. Front Endocrinol (Lausanne). 2025;DOI: 10.3389/fendo.2025.1545393.
