Maternal serum triglyceride at 24-32 weeks' gestation and newborn weight in nondiabetic women with positive diabetic screens

Objective: To determine whether elevated midpregnancy maternal serum lipid levels predict newborn weight at term and the risk of large for gestational age (LGA) infants in women with positive diabetic screen but normal glucos e tolerance test. Methods: Japanese gravidas who had positive diabetic screens and normal 75- g oral glucose tolerance tests (GTT) at 24-32 weeks were enrolled. Subjects with complications, including diabetes, hypertension, or fetal anomalies w ere excluded, as were women with multifetal gestations. Fasting serum trigl yceride, free fatty acids, and total cholesterol levels were measured at th e time of GTT. We tested the association between maternal variables and bir th weight by univariable analysis. We used multivariable analysis to test w hether the association between fasting lipids and birth weight was independ ent of prepregnant maternal body mass index (BMI), maternal weight gain dur ing pregnancy, and plasma glucose levels at GTT. We also used multiple logi stic regression analysis to determine whether maternal hyperlipidemia, defi ned as more than the 75th percentile of each lipid, is a risk factor for ha ving an LGA infant. Results: We enrolled 146 subjects. Among measured maternal lipids, only tri glyceride levels correlated with birth weight in univariable analysis (r = 0.22, P =.009). Birth weight also was correlated with prepregnant maternal BMI (r = 0.18, P =.04) and fasting plasma glucose levels (r = 0.17, P =.04) . The association between maternal fasting triglyceride level and birth wei ght remained significant after adjusting for prepregnant BMI, maternal weig ht gain, fasting plasma glucose levels, fetal gender, and gestational age a t birth (P =.01). Logistic regression analysis showed that fasting maternal hypertriglyceridemia (over 259 mg/dL) was the significant predictor of LGA infants, independent of prepregnant BMI, maternal weight gain, and materna l plasma glucose levels (odds ratio 11.6; 95% confidence interval 1.1, 122; P =.04). Conclusion: In women with positive diabetic screens but normal GTTs, fastin g triglyceride levels at 24-32 weeks correlated positively with newborn wei ght at term, independent of maternal plasma glucose levels and obesity. Mat ernal fasting serum triglyceride levels in midpregnancy might be an indepen dent predictor of fetal macrosomia in those women. (Obstet Gynecol 2001;97: 776-80. (C) 2001 by The American College of Obstetricians and Gynecologists .).