Lipoprotein metabolism and vascular complications in pregnancy

Human pregnancy is characterized by striking changes in maternal metabolism and body composition in order to provide sufficient energy and nutrients to the developing fetus. There are marked increases in plasma lipid concentrations as gestation advances, with plasma cholesterol and triglyceride concentrations rising typically by 25-50% and 200-400%, respectively. These changes are due to the combined effect of increased adipose tissue lipolysis in late pregnancy and maternal hormonal changes. Essential fatty acids and cholesterol are transported to the fetus via the placenta. In women with additional metabolic stress, such as those with gestational diabetes mellitus and obesity, there are alterations in lipid and lipoprotein metabolism consistent with increased insulin resistance. In pre-eclampsia, there is an exaggerated early rise in plasma triglycerides and free fatty acid concentrations in combination with an increase in the proportion of small dense LDL and a lesser rise in HDL-C, changes that may contribute to the pathogenesis of the maternal syndrome. Adverse pregnancy outcomes including pre-eclampsia are associated with a modestly increased risk in later life of cardiovascular disease in the mother, whereas gestational diabetes is associated with a marked increased risk for future diabetes. Future studies should address to what extent maternal lipid changes in the above complications influence programming of the future health of offspring.