Association of Maternal and Umbilical Cord Blood Lipid Parameters with Uterine and Fetal-Placental Blood Flow in Hypertensive and Normotensive Pregnancies

Figures & data

Figure 1 Schematic presentation of the study cohort.

Table 1 Maternal and Neonatal Characteristics of Study Population

	All Subjects (N=812)	HDP (n=170)	Normotensive (n=642)	p-value*
Maternal Variables
Maternal age, years	28.07 (4.97)	27.86 (5.02)	28.13 (4.96)	0.530
Preconception BMI, kg/m^2	23.05 (1.64)	23.04 (1.80)	23.05 (1.59)	0.936
BMI before delivery, kg/m^2	27.85 (1.72)	27.93 (1.96)	27.82 (1.65)	0.488
Weight gain during pregnancy, kg	12.27 (1.29)	12.52 (1.34)	12.21 (1.28)	0.006
SBP, mmHg	129.06 (15.86)	149.83 (16.97)	123.55 (9.88)	<0.001
DBP, mmHg	77.83 (9.32)	87.14 (11.31)	75.36 (6.86)	<0.001
Parity:
Nulliparous	404 (49.8%)	102 (60%)	302 (47.04%)	0.003
Multiparous	408 (50.2%)	68 (40%)	340 (52.96%)
Cesarean section delivery	278 (34.2%)	99 (58.2%)	179 (27.9%)	<0.001
Neonatal Variables
Gestational age, weeks	38.34 (1.79)	37.14 (1.97)	38.66 (1.60)	<0.001
Gender (boy)	427 (52.59%)	94 (55.29%)	333 (51.87%)	0.426
First-minute APGAR	8.32 (1.23)	7.54 (1.43)	8.53 (1.09)	<0.001
Fifth-minute APGAR	9.31 (1.05)	8.76 (1.33)	9.45 (0.91)	<0.001
Weight, gr	2892.94 (288.30)	2831.92 (305.37)	2909.10 (281.64)	0.003
Height, cm	48.60 (2.80)	46.84 (3.22)	49.07 (2.48)	<0.001
Abdominal circumference, cm	31.62 (3.00)	29.98 (2.96)	32.05 (2.86)	<0.001
Head circumference, cm	34.20 (1.35)	33.64 (1.50)	34.34 (1.27)	<0.001

Notes: *P-values were derived from the comparisons between the HDP and normotensive groups.

Abbreviations: HDP, hypertensive disorders of pregnancy; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure.

Table 2 Doppler Indices and Lipid Parameters of the Study Population

	All Subjects (N=812)	HDP (n=170)	Normotensive (n=642)	p-value*
	Mean (SD)	Mean (SD)	Mean (SD)
Doppler Indices
UtA-PI	0.77 (0.17)	0.91 (0.17)	0.73 (0.15)	<0.001
UA-PI	0.77 (0.16)	0.92 (0.17)	0.73 (0.14)	<0.001
MCA-PI	1.73 (0.25)	1.61 (0.25)	1.77 (0.23)	<0.001
Maternal Lipid Parameters
TG, mg/dL	215.12(40.86)	236.15 (46.81)	209.55 (37.23)	<0.001
TC, mg/dL	224.80 (33.81)	240.14 (43.44)	220.74 (29.49)	<0.001
HDL-C, mg/dL	50.15 (7.22)	50.32 (8.69)	50.11 (6.78)	0.734
LDL-C, mg/dL	131.69 (29.94)	142.41 (36.73)	128.85(27.20)	<0.001
Non-HDL-C, mg/dL	174.97 (33.66)	190.17 (41.37)	170.95(30.07)	<0.001
UCB Lipid Parameters
TG, mg/dL	44.06 (14.04)	50.81 (19.93)	42.25 (11.35)	<0.001
TC, mg/dL	61.77 (11.39)	63.64 (12.90)	61.27 (10.90)	0.016
HDL-C, mg/dL	27.68 (5.73)	26.46 (6.60)	28.01 (5.43)	0.002
LDL-C, mg/dL	25.34 (9.27)	27.32 (9.54)	24.81 (9.13)	0.002
Non-HDL-C, mg/dL	34.09 (9.68)	37.18 (10.13)	33.26 (9.40)	<0.001

Notes: *P-values were derived from the comparisons between the HDP and normotensive groups.

Abbreviations: HDP, hypertensive disorders of pregnancy; UtA-PI, uterine artery pulsatility index; UA-PI, umbilical artery pulsatility index; MCA-PI, middle cerebral artery pulsatility index; TG, triglyceride; TC, total cholesterol; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; Non-HDL-C, non high density lipoprotein cholesterol; UCB, umbilical cord blood.

Table 3 Adjusted Odd Ratios for Abnormal Doppler According to Lipid Parameters in the Study Population

	HDP (n=170)		Normotensive (n=642)
	OR (95% CI)	p-value	OR (95% CI)	p-value
Association between maternal lipid parameters and abnormal UtA-PI^a
TG	1.033 (1.020–1.045)	<0.001*	1.007 (0.999–1.015)	0.072
TC	1.009 (0.999–1.019)	0.065	1.004 (0.993–1.014)	0.497
HDL-C	0.999 (0.957–1.044)	0.977	0.977 (0.934–1.022)	0.308
LDL-C	1.003 (0.993–1.014)	0.532	1.003 (0.991–1.014)	0.656
Non-HDL-C	1.011 (1.001–1.021)	0.039*	1.009 (0.999–1.018)	0.066
Association between UCB lipid parameters and abnormal UA-PI^b
TG	1.028 (1.001–1.053)	0.042*	1.025 (0.934–1.125)	0.597
TC	1.031 (0.984–1.080)	0.196	1.024 (0.890–1.177)	0.744
HDL-C	0.987 (0.914–1.065)	0.735	1.175 (0.888–1.555)	0.258
LDL-C	1.024 (0.967–1.083)	0.420	0.968 (0.839–1.117)	0.659
Non-HDL-C	1.053 (0.996–1.112)	0.067	0.975 (0.846–1.124)	0.728
Association between UCB lipid parameters and abnormal MCA-PI^b
TG	1.021 (1.003–1.039)	0.021*	1.015 (0.989–1.041)	0.275
TC	0.991 (0.945–1.039)	0.702	0.981(0.940–1.024)	0.377
HDL-C	0.960 (0.878–1.050)	0.377	1.038 (0.946–1.139)	0.433
LDL-C	0.991 (0.930–1.057)	0.788	0.951 (0.897–1.008)	0.090
Non-HDL-C	1.004 (0.944–1.067)	0.903	0.963 (0.917–1.011)	0.127

Notes: *Statistically significant. ^aModel 1 adjusted for maternal age, systolic and diastolic blood pressure, preconception BMI, weight gain during pregnancy, parity, and gestational age at the time of blood sampling. ^bModel 2 adjusted for all the risk factors adjusted in Model 1 in addition to gender of fetus, anthropometric measurements of newborn at birth, and maternal blood lipid parameters.

Abbreviations: HDP, hypertensive disorders of pregnancy; UtA-PI, uterine artery pulsatility index; UA-PI, umbilical artery pulsatility index; MCA-PI, middle cerebral artery pulsatility index; TG, triglyceride; TC, total cholesterol; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; Non-HDL-C, non high density lipoprotein cholesterol; UCB, umbilical cord blood.

Figure 2 (A) Adjusted odds ratios (OR) for abnormal UtA-PI across quartiles of maternal TG. (B) Adjusted odds ratios (OR) for abnormal UtA-PI across quartiles of maternal non-HDL-c. (C) Adjusted odds ratios (OR) for abnormal UA-PI across quartiles of UCB-TG. (D) Adjusted odds ratios (OR) for abnormal MCA-PI across quartiles of UCB-TG. *Statistically significant.

Abbreviations: UtA-PI, uterine artery pulsatility index; UA-PI, umbilical artery pulsatility index; MCA-PI, middle cerebral artery pulsatility index; TG, triglycerides; non-HDL, non-high-density lipoprotein.

Table 4 Adjusted Odd Ratios for Abnormal Doppler According to Lipid Parameters in Hypertensive Subgroups

	Preeclampsia (n=80)		Gestational Hypertension (n=90)
	OR (95% CI)	p-value	OR (95% CI)	p-value
Association between maternal lipid parameters and abnormal UtA-PI^a
TG	1.032 (1.015–1.049)	<0.001*	1.035 (1.013–1.058)	0.002*
TC	1.015 (1.001–1.029)	0.034*	0.997 (0.981–1.013)	0.674
HDL-C	1.027 (0.969–1.089)	0.372	0.929 (0.852–1.012)	0.092
LDL-C	1.010 (0.994–1.025)	0.214	0.988 (0.969–1.008)	0.248
Non-HDL-C	1.016 (1.001–1.032)	0.031*	0.999 (0.983–1.016)	0.936
Association between UCB lipid parameters and abnormal UA-PI^b
TG	1.084 (1.010–1.164)	0.026*	1.019 (0.980–1.059)	0.346
TC	1.022 (0.952–1.098)	0.544	1.230 (0.988–1.531)	0.064
HDL-C	0.984 (0.883–1.097)	0.775	1.105 (0.887–1.377)	0.374
LDL-C	1.009 (0.923–1.104)	0.842	1.081 (0.936–1.249)	0.290
Non-HDL-C	1.040 (0.956–1.131)	0.359	1.178 (0.991–1.399)	0.063
Association between UCB lipid parameters and abnormal MCA-PI^b
TG	1.062 (0.956–1.180)	0.266	0.998 (0.916–1.087)	0.964
TC	1.008 (0.906–1.122)	0.879	0.932 (0.850–1.022)	0.137
HDL-C	0.976 (0.849–1.122)	0.735	0.900 (0.743–1.090)	0.281
LDL-C	1.014 (0.893–1.151)	0.832	0.914 (0.807–1.034)	0.153
Non-HDL-C	1.029 (0.911–1.161)	0.650	0.918 (0.814–1.035)	0.162

Notes: *Statistically significant. ^aModel 1 adjusted for maternal age, systolic and diastolic blood pressure, preconception BMI, weight gain during pregnancy, parity, and gestational age at the time of blood sampling. ^bModel 2 adjusted for all of the risk factors adjusted in Model 1 in addition to gender of fetus, anthropometric measurements of newborn at birth, and maternal blood lipid parameters.

Abbreviations: UtA-PI, uterine artery pulsatility index; UA-PI, umbilical artery pulsatility index; MCA-PI, middle cerebral artery pulsatility index; TG, triglyceride; TC, total cholesterol; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; Non-HDL-C, non high density lipoprotein cholesterol; UCB, umbilical cord blood.