ArticleBMC pregnancy and childbirth2026
Trajectories of and trimester-specific six maternal lipid indices during pregnancy associated with preterm birth and its subtypes: a cohort-based record-linkage study.
Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveMaternal dyslipidemia during pregnancy affects occurrence of preterm birth (PTB), either spontaneous or iatrogenic, with varied mechanisms. This study aims at the trajectories of and trimester-specific six maternal lipids indices in relation to PTB and its subtypes.
methodsA cohort study was established on pregnant women who were screened for Down syndrome and followed up till termination of pregnancy. Lipid data were extracted from electronic medical records including triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C), and then linked with the cohort above. Non-HDL-C and atherogenic index of plasma (AIP) were calculated. Lipid dynamics across gestation were characterized by a generalized additive mixed model. Associations, overall and dose-response, of lipids with PTB and its subtypes were estimated respectively by a multivariable logistic regression model and a restricted cubic spline analysis.
resultsAmong the 2,749 pregnant women included in the final analysis, 137 (5.0%) delivered preterm. The six lipid indices differed in patterns across gestation. PTB-specific trajectories were clearly distinguishable from those of term birth for AIP throughout pregnancy and TG after about 20 weeks of gestation. Further, mid-pregnancy increments in AIP were strongly associated with higher odds of PTB (adjusted odds ratio [aOR] = 1.36, 95% confidence interval [CI]: 1.06-1.74 per standard deviation [SD]) and its iatrogenic subtype (aOR = 1.58, 95% CI: 1.05-2.38 per SD), and in a linear dose response. The aORs ranged from 1.29 to 1.50 for PTB with mid-pregnancy TG or non-HDL-C, iatrogenic PTB with mid-pregnancy TG or late-pregnancy TC, spontaneous PTB with mid-pregnancy non-HDL-C, and preterm premature rupture of the membranes with TG in mid-pregnancy, all per SD increment of the lipids above.
conclusionsMaternal lipids display distinct trajectories across gestation and affect occurrence of PTB. Disturbance of the TG-HDL-C axis such as high AIP, TG and non-HDL-C in mid- and late- pregnancy plays an important role on PTB, especially for its iatrogenic subtype.
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