Publicado
Hypertriglyceridemia and adverse outcomes during pregnancy
Hipertrigliceridemia y consecuencias adversas en el embarazo
DOI:
https://doi.org/10.15446/revfacmed.v66n2.60791Palabras clave:
Pregnancy, Hypertriglyceridemia, Maternal-Fetal Exchange, Fetal Development, Pregnancy Complications (en)Embarazo, Hipertrigliceridemia, Intercambio materno-fetal, Desarrollo fetal, Complicaciones del embarazo (es)
Descargas
Introduction: During pregnancy, levels of maternal serum triglycerides increase as a physiological adaptation mechanism to meet the needs of the developing fetus. However, although an excessive increase has been associated with preeclampsia, macrosomia and preterm delivery, the levels from which measurements should be taken in each trimester to prevent complications have not been established conclusively.
Objective: To review the physiopathology, effects on mother and child, expected values in each trimester and therapeutic interventions in maternal hypertriglyceridemia.
Materials and methods: A review was made based on a search of articles in the ScienceDirect, Pubmed, Scopus, LILACS, Cochrane and SciELO databases, with the terms: Pregnancy; Hypertriglyceridemia; Maternal-Fetal Exchange; Fetal Development; Pregnancy Complications in English and its equivalents in Spanish.
Results: 59 articles met the search criteria and responded to the objectives.
Conclusions: The limited amount and the great variability of the data indicate the need to carry out further research to establish the normal triglycerides ranges during the three trimesters of pregnancy and to determine risks and effective interventions before pregnancy in order to reduce maternal and child morbidity and mortality.
Introducción. Durante el embarazo, los niveles séricos de triglicéridos maternos aumentan como un mecanismo de adaptación fisiológica para suplir las necesidades del feto en desarrollo. Pese a que el incremento excesivo se ha asociado a preeclampsia, macrosomía y parto pretérmino, no se han establecido de manera contundente los niveles a partir de los cuales se deben tomar medidas en cada trimestre para prevenir complicaciones.
Objetivo. Hacer una revisión sobre fisiopatología, efectos en madre e hijo, valores esperados en cada trimestre e intervenciones terapéuticas en hipertrigliceridemia gestacional.
Materiales y métodos. Se realizó una revisión con la búsqueda de artículos en las bases de datos ScienceDirect, PubMed, Scopus, LILACS, Cochrane y SciELO con los términos: Pregnancy; Hypertriglyceridemia; Maternal-Fetal Exchange; Fetal Development; Pregnancy Complications y sus equivalentes en español.
Resultados. Se encontraron 59 artículos que cumplieron los criterios de búsqueda y daban respuesta a los objetivos.
Conclusiones. El número limitado y la gran variabilidad de los datos indican la necesidad de realizar más investigaciones que establezcan los rangos de normalidad de los triglicéridos durante los tres trimestres del embarazo y así determinar riesgos e intervenciones eficaces antes de la gestación y reducir la morbimortalidad materno-infantil.
Referencias
Wild R, Weedin EA, Gill EA. Women’s Health Considerations for Lipid Management. Endocrinol Metab Clin North Am. 2016;45(1):65-85. http://doi.org/f8fxx5.
Herrera E, Desoye G. Maternal and fetal lipid metabolism under normal and gestational diabetic conditions. Horm Mol Biol Clin Investig. 2016;26(2):109-27. http://doi.org/cgf8.
Vrijkotte TG, Krukziener N, Hutten BA, Vollebregt KC, Van Eijsden M, Twickler MB. Maternal lipid profile during early pregnancy and pregnancy complications and outcomes: The ABCD study. J Clin Endocrinol Metab. 2012;97(11):3917-25. http://doi.org/f4b9ns.
Niromanesh S, Shirazi M, Dastgerdy E, Sharbaf FR, Shirazi M, Khazaeipour Z. Association of hypertriglyceridaemia with pre-eclampsia, preterm birth, gestational diabetes and uterine artery pulsatility index. Natl Med J India. 2012;25(5):265-7.
El Khouly NI, Sanad ZF, Saleh SA, Shabana AA, Elhalaby AF, Badr EE. Value of first-trimester serum lipid profile in early prediction of preeclampsia and its severity: A prospective cohort study. Hypertens Pregnancy. 2016;35(1):73-81. http://doi.org/cgf9.
Cruz J, Grandía R, Padilla L, Rodríguez S, Hernández-García P, Lang-Prieto J, et al. Macrosomia Predictors in Infants Born to Cuban Mothers with Gestational Diabetes. MEDICC Rev. 2015;17(3):27-32.
Instituto Nacional de Salud. Enfermedades no trasmitibles. Bogotá, D.C.: Boletín Epidemiológico No 21; 2016.
Mayret-Mesquiti M, Pérez-Méndez O, Rodríguez ME, Fortoul TI, Gorocica P, Bernal-Alcántara D, et al. Hypertriglyceridemia is linked to reduced nitric oxide synthesis in women with hypertensive disorders of pregnancy. Hypertens pregnancy. 2007;26(4):423-31. http://doi.org/dtkhxg.
Capobianco E, Martínez N, Fornes D, Higa R, Di Marco I, Basualdo MN, et al. PPAR activation as a regulator of lipid metabolism, nitric oxide production and lipid peroxidation in the placenta from type 2 diabetic patients. Mol Cell Endocrinol. 2013;377(1-2):7-15. http://doi.org/f48stf.
Jawerbaum A, Capobianco E. Review: Effects of PPAR activation in the placenta and the fetus: Implications in maternal diabetes. Placenta. 2011;32(Suppl 2):S212-7. http://doi.org/bgxzfh.
Olmos PR, Rigotti A, Busso D, Berkowitz L, Santos JL, Borzone GR, et al. Maternal hypertriglyceridemia: A link between maternal overweight-obesity and macrosomia in gestational diabetes. Obesity (Silver Spring). 2014;22(10):2156-63. http://doi.org/cggb.
Olmos P, Martelo G, Reimer V, Rigotti A, Busso D, Belmar C, et al. La hipótesis de Pedersen no es suficiente: Otros nutrientes además de la glucosa explicarían la macrosomía fetal en pacientes diabéticas gestacionales con sobrepeso y buen control glicémico. Rev méd Chile. 2013;141(11):1441-8. http://doi.org/cggh.
Heim C, Newport DJ, Heit S, Graham YP, Wilcox M, Bonsall R, et al. Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. JAMA. 2000;284(5):592-7. http://doi.org/df2w76.
Ferriols E, Rueda C, Gamero R, Vidal M, Payá A, Carreras R, et al. Comportamiento de los lípidos durante la gestación y su relación con acontecimientos obstétricos desfavorables. Clin Invest Arterioscl. 2016;28(5):232-44. http://doi.org/f3gxhv.
Gupta N, Ahmed S, Shaffer L, Cavens P, Blankstein J. Severe hypertriglyceridemia induced pancreatitis in pregnancy. Case Rep Obstet Gynecol. 2014;2014:485-93. http://doi.org/f3gxhv.
Barrett HL, Dekker-Nitert M, McIntyre HD, Callaway LK. Normalizing metabolism in diabetic pregnancy: is it time to target lipids? Diabetes Care. 2014;37(5):1484-93. http://doi.org/f5zbr4.
McGladdery SH, Frohlich JJ. Lipoprotein lipase and apoE polymorphisms: relationship to hypertriglyceridemia during pregnancy. J Lipid Res. 2001;42(11):1905-12.
Ward KJ, Shields B, Knight B, Salzmann MB, Hattersley AT, Frayling TM. Genetic variants in Apolipoprotein AV alter triglyceride concentrations in pregnancy. Lipids Health Dis. 2003;2:9. http://doi.org/dccv7x.
Montelongo A, Lasunción MA, Pallardo LF, Herrera E. Longitudinal-Study of Plasma lipoproteins and Hormones During Pregnancy in Normal and Diabetic Women. Diabetes. 1992;41(12):1651-9. http://doi.org/cggn.
Sjöström L, William-Olsson T. Prospective studies on adipose tissue development in man. Int J Obes. 1981;5(6):597-604.
Jin WY, Lin SL, Hou RL, Chen XY, Han T, Jin Y, et al. Associations between maternal lipid profile and pregnancy complications and perinatal outcomes: a population-based study from China. BMC Pregnancy Childbirth. 2016;16(1):60. http://doi.org/cggp.
Siddiqui I. Maternal Serum Lipids in Women with Pre-eclampsia. Ann Med Health Sci Res. 2014;4(4):638-41. http://doi.org/gcb4px.
Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet. 2010;376(9741):631-44. http://doi.org/d3cbtp.
Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066-74. http://doi.org/dst3wb.
Duley L. The Global Impact of Pre-eclampsia and Eclampsia. Semin Perinatol. 2009;33(3):130-7. http://doi.org/bqvddg.
Kumru S, Aydin S, Gursu MF, Ozcan Z. Changes of serum paraoxonase (an HDL-cholesterol-associated lipophilic antioxidant) and arylesterase activities in severe preeclamptic women. Eur J Obstet Gynecol Reprod Biol. 2004;114(2):177-81. http://doi.org/b8bnmg.
Manna FN, Khanam NN, Chowdhury KA, Das SN, Kabir MA, Zubyra SJ, et al. Study on Association of Maternal Serum Triglyceride with Pre-eclampsia. Mymensingh Med J. 2015;24(3):578-84.
Qiu C, Phung TT, Vadachkoria S, Muy-Rivera M, Sanchez SE, Williams MA. Oxidized low-density lipoprotein (Oxidized LDL) and the risk of preeclampsia. Physiol Res. 2006;55(5):491-500.
Kadam L, Kohan-Ghadr HR, Drewlo S. The balancing act - PPAR-γ’s roles at the maternal-fetal interface. Syst Biol Reprod Med. 2015;61(2):65-71. http://doi.org/cghz.
Bowers K, Tobias DK, Yeung E, Hu FB, Zhang C. A prospective study of prepregnancy dietary fat intake and risk of gestational diabetes. Am J Clin Nutr. 2012;95(2):446-53. http://doi.org/fx2bnx.
Khan R, Ali K, Khan Z, Ahmad T. Lipid profile and glycosylated hemoglobin status of gestational diabetic patients and healthy pregnant women. Indian J Med Sci. 2012;66(7-8):149-54. http://doi.org/cgh2.
Han ES, Krauss RM, Xu F, Sridhar SB, Ferrara A, Quesenberry CP, et al. Prepregnancy adverse lipid profile and subsequent risk of gestational diabetes. J Clin Endocrinol Metab. 2016;101(7):2721-7. http://doi.org/f8wn58.
Gunderson EP, Quesenberry CP Jr, Jacobs DR Jr, Feng J, Lewis CE, Sidney S. Longitudinal study of prepregnancy cardiometabolic risk factors and subsequent risk of gestational diabetes mellitus: The CARDIA study. Am J Epidemiol. 2010;172(10):1131-43. http://doi.org/bdcc96.
Enquobahrie DA, Williams MA, Butler CL, Frederick IO, Miller RS, Luthy DA. Maternal plasma lipid concentrations in early pregnancy and risk of preeclampsia. Am J Hypertens. 2004;17(7):574-81. http://doi.org/bwbc23.
Merzouk H, Khan NA. Implication of lipids in macrosomia of diabetic pregnancy: can n-3 polyunsaturated fatty acids exert beneficial effects? Clin Sci (Lond). 2003;105(5):519-29. http://doi.org/bkxcc8.
Zhang X, Decker A, Platt RW, Kramer MS. How big is too big? The perinatal consequences of fetal macrosomia. Am J Obstet Gynecol. 2008;198(5):517.e1-6. http://doi.org/c9z643.
Chauhan SP, Grobman WA, Gherman RA, Chauhan VB, Chang G, Magann EF, et al. Suspicion and treatment of the macrosomic fetus: A review. Am J Obstet Gynecol. 2005;193(2):332-46. http://doi.org/bqm56b.
Catalano PM. Management of obesity in pregnancy. Obstet Gynecol. 2007;109(2 Pt 1):419-33. http://doi.org/fw6tnr.
Ehrenberg HM, Mercer BM, Catalano PM. The influence of obesity and diabetes on the prevalence of macrosomia. Am J Obstet Gynecol. 2004;191(3):964-8. http://doi.org/d38phg.
Ricart W, López J, Mozas J, Pericot A, Sancho MA, González N, et al. Body mass index has a greater impact on pregnancy outcomes than gestational hyperglycaemia. Diabetologia. 2005;48(9):1736-42. http://doi.org/bsq766.
Verhaeghe J, Pintiaux A, van Herck E, Hennen G, Foidart J-M, Igout A. Placental GH, IGF-I, IGF-Binding Protein-1, and Leptin during a Glucose Challenge Test in Pregnant Women: Relation with Maternal Body Weight, Glucose Tolerance, and Birth Weight. J Clin Endocrinol Metab. 2002;87(6):2875-82. http://doi.org/cgh4.
de Vries PS, Gielen M, Rizopoulos D, Rump P, Godschalk R, Hornstra G, et al. Association between polyunsaturated fatty acid concentrations in maternal plasma phospholipids during pregnancy and offspring adiposity at age 7: The MEFAB cohort. Prostaglandins Leukot Essent Fatty Acids. 2014;91(3):81-5. http://doi.org/f6fh2b.
Meher AP, Wadhwani N, Randhir K, Mehendale S, Wagh G, Joshi SR. Placental DHA and mRNA levels of PPARγ and LXRα and their relationship to birth weight. J Clin Lipidol. 2016;10(4):767-74. http://doi.org/f83xmg.
Steffen KM, Cooper ME, Shi M, Caprau D, Simhan HN, Dagle JM, et al. Maternal and fetal variation in genes of cholesterol metabolism is associated with preterm delivery. J Perinatol. 2007;27(11):672-80. http://doi.org/bxgk2r.
Magnussen EB, Vatten LJ, Myklestad K, Salvesen KÅ, Romundstad PR. Cardiovascular risk factors prior to conception and the length of pregnancy: population-based cohort study. Am J Obstet Gynecol. 2011;204(6):526.e1-8. http://doi.org/b5qbkw.
Mattison DR, Damus K, Fiore E, Petrini J, Alter C. Preterm delivery: a public health perspective. Paediatr Perinat Epidemiol. 2001;15(Suppl 2):7-16. http://doi.org/dxt4g7.
Pusukuru R, Shenoi AS, Kyada PK, Ghodke B, Mehta V, Bhuta K, et al. Evaluation of Lipid Profile in Second and Third Trimester of Pregnancy. J Clin Diagnostic Res. 2016;10(3):12-6. http://doi.org/cgh6.
Landázuri P, Restrepo B, Trejos J, Gallego ML, Loango-Chamorro N, Ocampo R. Perfil lipídico por trimestres de gestación en una población de mujeres colombianas. Rev Colomb Obstet Ginecol. 2006;57(4):256-63.
Ywaskewycz-Benítez LR, Bonneau GA, Castillo-Rascón MS, López DL, Pedrozo WR. Perfil lipídico por trimestre de gestación en una población de mujeres adultas. Rev Chil Obstet Ginecol. 2010;75(4):227-33. http://doi.org/dpqh2r.
Becerra-Leal AV, Salas-Paredes A, Buela L, Sosa MA, Arata-Bellabarba G, Valeri L, et al. Índice trigliceridos/cHDL en el embarazo: Interrelación con índices de resistencia a la insulina y antropometría fetal. Rev Venez Endocrinol y Metab. 2013;11(3):141-6.
Hersberger M, von Eckardstein A. Low high-density lipoprotein cholesterol: physiological background, clinical importance and drug treatment. Drugs. 2003;63(18):1907-45. http://doi.org/dvm9pp.
Valenzuela BR, Barrera RC, Gonzalez-Astorga M, Sanhueza CJ, Valenzuela BA. Alpha linolenic acid (ALA) from Rosa canina, sacha inchi and chia oils may increase ALA accretion and its conversion into n-3 LCPUFA in diverse tissues of the rat. Food Funct. 2014;5(7):1564–72. http://doi.org/ckck.
Gürsoy A, Kulaksizoglu M, Sahin M, Ertugrul DT, Ozer F, Tutuncu NB, et al. Severe hypertriglyceridemia-induced pancreatitis during pregnancy. J Natl Med Assoc. 2006;98(4):655-7.
Safi F, Toumeh A, Abuissa-Qadan MA, Karaz R, AlAkdar B, Assaly R. Management of familial hypertriglyceridemia-induced pancreatitis during pregnancy with therapeutic plasma exchange: a case report and review of literature. Am J Ther. 2014;21(5):e134-6. http://doi.org/cgh7.
Altun D, Eren G, Cukurova Z, Hergünsel O, Yasar L. An alternative treatment in hypertriglyceridemia-induced acute pancreatitis in pregnancy: Plasmapheresis. J Anaesthesiol Clin Pharmacol. 2012;28(2):252-4. http://doi.org/f3xftm.
Vandenbroucke L, Seconda S, Lassel L, Le Bouar G, Poulain P. Pancréatite aiguë secondaire à une hypertriglycéridémie majeure au cours de la grossesse. À propos d’un cas. J Gynecol Obstet Biol Reprod (Paris). 2009;38(5):436-9. http://doi.org/cbq964.
Kern-Pessôa VN, Rodacki M, Negrato CA, Zajdenverg L. Changes in lipid profile after treatment of women with gestational diabetes mellitus. J Clin Lipidol. 2016;10(2):350-5. http://doi.org/f8htrw.
Dimensions
PlumX
Visitas a la página del resumen del artículo
Descargas
Cómo citar
Licencia
Derechos de autor 2018 Revista de la Facultad de Medicina
Esta obra está bajo una licencia Creative Commons Reconocimiento 3.0 Unported.
-
