Lipids and Women's Health: Recent Updates and Implications for Practice

The association between pregnancy levels of blood lipids and the risk of preterm birth

Preterm labor, a condition associated with various risk factors such as a history of prior preterm birth (PTB) and multiple pregnancies, has recently seen an increasing focus on its potential link with dyslipidemia. This study aims to investigate the relationship between dyslipidemia in expectant mothers and the risks of PTB. We studied 6963 mothers who gave birth at the International Peace Maternal and Child Health Hospital of Shanghai Jiaotong University School of Medicine in 2020, among which, 437 women had PTB. We extracted clinical and lipid data from electronic records, using multivariable logistic regression and restricted cubic spline models to explore the link between lipid concentrations (by quartiles) in pregnancy stages and PTB risk. The PTB rate was 6.3%. Early pregnancy in the PTB group showed elevated ApoA, ApoB, CHOL, LDL, and TG levels compared to controls (all P < 0.05). Late pregnancy showed no notable lipid differences. Multivariable analysis revealed elevated ApoA, TG, higher age, BMI ≥ 28 kg/m2, hypertension, assisted reproductive technology and gestational diabetes as PTB risk factors (all P < 0.05). After adjustments, higher ApoA, ApoB, CHOL and TG levels correlated with increased PTB risk. Using the lowest quartile, the adjusted ORs for early pregnancy's highest quartile of ApoA, ApoB, CHOL and TG were 1.348, 1.442, 1.442 and 2.156, respectively. Our findings indicate that dyslipemia in early pregnancy, including elevated levels of ApoA, ApoB, CHOL and TG, are associated with PTB. Managing lipid abnormalities during pregnancy may help reduce the risk of PTB.

The Influence of Maternal Aerobic Exercise, Blood DHA and EPA Concentrations on Maternal Lipid Profiles

Exercise and polyunsaturated fatty acid (PUFA) supplementation independently improve lipid profiles. The influence of both exercise and PUFAs on lipids during pregnancy remains unknown. This study evaluated exercise, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) concentrations on lipids during pregnancy. Participants were randomized to aerobic exercise or control groups. From 16 weeks gestation until delivery, groups met 3x/week; exercisers performed moderate-intensity aerobic activity, controls performed low-intensity stretching and breathing. At 16 and 36 weeks’ gestation, maternal blood was analyzed for lipids (total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG)), DHA and EPA. In intent-to-treat analysis, the aerobic group (n = 20), relative to controls (n = 10), exhibited a higher HDL change across gestation (p = 0.03). In a per protocol analysis, the aerobic group, relative to controls, exhibited 21.2% lower TG at 36 weeks (p = 0.04). After controlling for 36-week DHA and EPA, exercise dose predicts 36 weeks’ TG (F (1,36) = 6.977, p = 0.012, r² = 0.16). Aerobic exercise normalizes late pregnancy TG. During pregnancy, exercise dose controls the rise in TG, therefore maintaining normal levels. DHA and EPA do not have measurable effects on lipids. Regardless of PUFA levels, exercise at recommended levels maintains appropriate TG levels in pregnant women. Normal TG levels are critical for pregnancy outcomes, and further studies are warranted to investigate this association in broader populations.

Lipid Profiles of College Female Student-Athletes Participating at Different Competition Levels of Organized Sport

College-aged women are not meeting weekly moderate-to-vigorous physical activity to support lipids protecting against cardiovascular disease onset. Participating in organized sport could assist in physical activity engagement and maintenance while positively impacting lipids predicting cardiovascular disease. However, women may be discouraged from participating in sports if they perceive benefits to be mostly seen at the higher competition levels, thus hindering seeking sports involvement at lesser-intensity levels. A total of N = 78 female athletes participating at the National Collegiate Athletic Association (n = 21), National Junior College Athletic Association (n = 29), and student club (n = 28) completed a personal characteristics questionnaire and provided blood samples to compare physical activity involvement and lipid health profiles. Linear regression modeling was used to assess how the independent variables (i.e., sport level, age, systolic blood pressure, race/ethnicity, sport/physical activity involvement hours per week, and years playing sports) on the dependent variables [i.e., total cholesterol, high density lipid (HDL), and total cholesterol-HDL ratio]. Total sample cholesterol 165.7 ± 34.0, HDL 62.8 ± 15.03, and total cholesterol-HDL ratio 2.8 ± 0.6 were all within a healthy recommendation range, along with per sport level. NJCAA sport level significantly predicted lower total cholesterol, p = 0.043, while identifying as Black significantly predicted higher total cholesterol, p = 0.008. Similarly, identifying as Black significantly predicted higher HDL, p = 0.021. Furthermore, increased systolic blood pressure significantly predicted higher total cholesterol-HDL ratios, p = 0.014. Organized sports participation may help meet physical activity requirements, support healthy lipid profiles, and ward off cardiovascular disease development in female college students regardless of competition level.