Journal of obstetrics and women's diseasesJournal of obstetrics and women's diseasesЖурнал акушерства и женских болезней1684-04611683-9366Eco-Vector4856610.17816/JOWD48566Original study articlesОригинальные исследованияResearch ArticleThe role of dyslipidemia in the pathogenesis of perinatal complications in pregnant women with diabetes mellitusРоль дислипидемии в патогенезе перинатальных осложнений при сахарном диабете у материhttps://orcid.org/0000-0002-2783-3032G-3759-20157300-6260KapustinRoman V.КапустинРоман Викторович
Russian Federation

MD, PhD, Secretary Scientific, obstetrician-gynecologist

кандидат медицинских наук, ученый секретарь, врач акушер-гинеколог

kapustin.roman@gmail.comhttps://orcid.org/0000-0001-5803-1668ABB-6930-20203466-7910TsybukElizaveta M.ЦыбукЕлизавета Михайловна
Russian Federation

medical student

студент медицинского факультета

elizavetatcybuk@gmail.comhttps://orcid.org/0000-0003-1409-5680W-3735-20173976-2540AlexeyenkovaElena N.АлексеенковаЕлена Николаевна
Russian Federation

Junior Researcher of the Department of Obstetrics and Perinatology

младший научный сотрудник отдела акушерства и перинатологии

ealekseva@gmail.comhttps://orcid.org/0000-0002-9328-89099421-6407KopteyevaEkaterina V.КоптееваЕкатерина Вадимовна
Russian Federation

Clinical Resident of the Department of Obstetrics, Gynecology and Reproductology

клинический ординатор кафедры акушерства, гинекологии и репродуктологии

ekaterina_kopteeva@bk.ruhttps://orcid.org/0000-0003-3059-9811G-6895-20157910-6039ArzhanovaOlga N.АржановаОльга Николаевна
Russian Federation

MD, PhD, DSci (Medicine),Professor, Honoured Doctor of the Russian Federation

д-р мед. наук,профессор, засл. врач РФ

olga_arjanova@mail.ruhttps://orcid.org/0000-0001-5133-23962719-5432OparinaTatyana I.ОпаринаТатьяна Ивановна
Russian Federation

PhD, Senior Researcher, Laboratory of biochemistry

кандидат биологических наук, старший научный сотрудник лаборатории биохимии

oparinat@mail.ruTumasovaZhanna N.ТумасоваЖанна Николаевна
Russian Federation

laboratory doctor

врач-лаборант

iagmail@ott.ruThe Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. OttНаучно-исследовательский институт акушерства, гинекологии и репродуктологии им. Д.О. ОттаSaint Petersburg State UniversityСанкт-Петербургский государственный университетThe Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. OttНаучно-исследовательский институт акушерства, гинекологии и репродуктологии им. Д.О. Отта08042021701891002610202023122020Copyright ©; 2021, Eсо-VectorCopyright ©; 2021, ООО «Эко-Вектор»Copyright ©; 2021, Kapustin R., Tcybuk E., Alekseenkova E., Kopteeva E., Arzhanova O., Oparina T., Tumasova Z.2021Eсо-VectorООО «Эко-Вектор»Kapustin R., Tcybuk E., Alekseenkova E., Kopteeva E., Arzhanova O., Oparina T., Tumasova Z.https://journals.eco-vector.com/jowd/article/view/48566

HYPOTHESIS/AIMS OF STUDY: The prevalence of diabetes mellitus in pregnant women is increasing. Physiological hyperlipidemia is usually developed during the last third of gestation, increases during pregnancies complicated by diabetes mellitus. Abnormal lipid profiles are associated with adverse perinatal outcomes. However, the associations between maternal dyslipidemia and pregnancy complications in women with different diabetes mellitus types remain unclear. The aim of this study was to assess the lipid profile in women with different types of diabetes mellitus (Type 1, Type 2, and gestational diabetes) based on the therapy in the third trimester of pregnancy, to investigate the associations between serum lipid profile and perinatal complications, and to determine possible prognostic value of lipids in the development of adverse pregnancy outcomes.

STUDY DESIGN, MATERIALS AND METHODS: The study included 277 women who were divided into several groups depending on the type of diabetes mellitus and its therapy method, a group of patients with preeclampsia, and the control group. We analyzed the clinical and laboratory data of outpatient and inpatient cards of pregnant women in the period between 2010 and 2017. Maternal blood samples were collected between 28 and 32 weeks of gestation. The samples were assayed for fasting triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and very-low-density lipoprotein cholesterol concentrations, as well as the atherogenic index of plasma. We also assessed the incidence of gestational arterial hypertension, preeclampsia, intrauterine growth restriction, and preterm birth.

RESULTS: Pregnant women with various types of diabetes mellitus were characterized by a significant rise in serum triglycerides and very-low-density lipoprotein cholesterol levels, an increase in the atherogenic index of plasma, and a significant decrease in antiatherogenic, high-density lipoprotein cholesterol levels. These changes were most pronounced in pregnant women with pregestational diabetes mellitus types and in groups receiving insulin therapy. Correlation analysis revealed weak positive correlations between serum triglycerides concentrations and macrosomia (r = 0.26) and between the atherogenic index of plasma and severe preeclampsia (r = 0.26). The analysis of the ROC curve showed that triglycerides, very-low-density lipoprotein cholesterol, and the atherogenic index of plasma are predictors of severe preeclampsia.

CONCLUSION: Diabetic pregnancies are associated with increased dyslipidemia, which plays an essential role in the pathogenesis of perinatal complications. Evaluating lipid profile markers in the third trimester of diabetic pregnancy may be valid predictors of severe preeclampsia.

Актуальность. Заболеваемость сахарным диабетом среди беременных растет. Физиологическая гиперлипидемия, характерная для поздних сроков гестации, усиливается во время беременности, осложненной сахарным диабетом. Изменения липидного профиля неразрывно связаны с неблагоприятными перинатальными исходами. Однако исследований, направленных на изучение взаимосвязи липидного обмена у женщин с различными типами сахарного диабета и развитием акушерских осложнений, недостаточно.

Цель — оценить липидный профиль у женщин с различными типами сахарного диабета (1-й, 2-й типы и гестационный сахарный диабет) с учетом метода его коррекции в III триместре беременности, выявить взаимосвязь липидов с перинатальными осложнениями, а также определить их возможную прогностическую значимость в развитии неблагоприятных исходов беременности.

Материалы и методы исследования. В исследование включено 277 женщин, которые составили несколько групп сравнения в зависимости от типа сахарного диабета и метода его коррекции, группу женщин с преэклампсией и группу условно здоровых. Анализировали клинические и лабораторные данные амбулаторных и стационарных карт беременных, находящихся на диспансерном учете в период с 2010 по 2017 г. Для исследования использовали периферическую венозную кровь, взятую у беременных натощак при сроке 28–32 нед. За первичную точку исследования принимали показатели содержания триглицеридов, холестерина, липопротеинов высокой, низкой и очень низкой плотности, коэффициент атерогенности. Дополнительно оценивали частоту гестационной артериальной гипертензии, преэклампсии, задержки развития плода, преждевременных родов.

Результаты исследования. Для беременных с различными типами сахарного диабета характерно преобладание в сыворотке крови атерогенных липидов (триглицериды, липопротеины очень низкой плотности), повышение индекса атерогенности и снижение содержания антиатерогенных липопротеинов высокой плотности. Эти изменения наиболее выражены у беременных с прегестационными типами сахарного диабета и в группах пациентов, получающих инсулинотерапию. При проведении корреляционного анализа выявлена слабая прямая связь между уровнем триглицеридов и макросомией (r = 0,26) и между значением индекса атерогенности и развитием тяжелой преэклампсии (r = 0,26). Анализ ROC-кривой показал, что триглицериды, липопротеины очень низкой плотности, индекс атерогенности являются предикторами развития тяжелой преэклампсии.

Заключение. Сахарный диабет усиливает состояние дислипидемии у беременных, что играет важную роль в патогенезе многих перинатальных осложнений. Оценка маркеров липидного профиля у женщин с различными типами сахарного диабета в III триместре беременности может являться валидным методом предикции тяжелой преэклампсии.

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