Remnant Cholesterol Levels Linked to Gestational Diabetes Risk

Higher remnant cholesterol levels during early pregnancy are associated with an increased risk for gestational diabetes, according to study results published in Lipids in Health and Disease.

Although previous research findings suggest a link between remnant cholesterol and the development of type 2 diabetes, the link between remnant cholesterol and gestational diabetes among pregnant individuals remains unclear.

Researchers conducted a prospective birth cohort study using the China Birth Cohort Study to explore the associations between remnant cholesterol levels during the first trimester and gestational diabetes risk. Female individuals with singleton pregnancies and without prediabetes or hypertension were eligible for inclusion.  

Participants underwent 75-g oral glucose tolerance tests between 24 and 28 weeks of gestation. Gestational diabetes was diagnosed if blood glucose exceeded: 92 mg/dL during fasting; 180 mg/dL at 1 hour; or, 153 mg/dL at 2 hours.

During the first pregnancy trimester, the participants (N=33,018; mean age at delivery, 31.96 years) were grouped into remnant cholesterol quartiles. Higher quartiles tended to have higher mean age, higher obesity rates, higher rates of assisted reproductive technology use, and higher rates of multiple pregnancies.

The mean remnant cholesterol level was 0.47 mmol/L. Laboratory measurements in the first trimester, including fasting blood glucose, triglycerides, total cholesterol, and high-density and low-density lipoprotein cholesterol, showed significant differences across quartiles (P <.001). Overall, 15.19% of participants developed gestational diabetes, with a prevalence of 19.24% in the highest quartile (P <.001).

The logistic regression analysis revealed a significant association between remnant cholesterol levels and gestational diabetes risk (odds ratio (OR), 2.254; 95% CI, 1.943-2.615). This risk increased with higher remnant cholesterol quartiles, with adjusted ORs of 1.086 for Q2, 1.208 for Q3, and 1.489 for Q4 compared with Q1. Further analysis confirmed a linear relationship between remnant cholesterol levels and gestational diabetes risk (P <.001).

Mediation analysis indicated that pre-body mass index (BMI) accounted for 9.20% of the relationship, whereas fasting blood glucose levels exhibited a negative mediating effect of -11.10%.

Study limitations include its being a single-center study, a lack of data on lipid changes after the first trimester, and the calculation rather than measurement of remnant cholesterol.

The study authors concluded, “These findings indicated that monitoring the levels of [remnant cholesterol] during early pregnancy may help to prevent [gestational diabetes] in a timely manner.”