ABSTRACT
OBJECTIVE: To construct valid reference standards reflecting optimal cerebroplacental ratio and to explore its physiological determinants. METHODS: A cohort of 391 low-risk pregnancies of singleton pregnancies of nonmalformed fetuses without maternal medical conditions and with normal perinatal outcomes was created. Doppler measurements of the middle cerebral artery and umbilical artery were performed at 24-42 weeks. Reference standards were produced, and the influence of physiological determinants was explored by nonparametric quantile regression. The derived standards were validated in a cohort of 200 low-risk pregnancies. RESULTS: Maternal body mass index was significantly associated with the 5th centile of the cerebroplacental ratio. For each additional unit of body mass index, the 5th centile was on average 0.014 lower. The derived 5th, 10th, and 50th centiles selected in the validation cohort were 5, 9.5, and 51% of the measurements. CONCLUSIONS: This study provides methodologically sound prescriptive standards and suggests that maternal body mass index is a determinant of a cutoff commonly used for decision-making.
ABSTRACT
Los lípidos juegan un importante papel durante la gestación, y en este periodo tienen lugar cambios importantes en el metabolismo lipoproteico. Durante el tercer trimestre del embarazo los niveles plasmáticos de colesterol y triglicéridos se ven sustancialmente incrementados, volviendo a niveles normales tras el parto. Se han descrito asociaciones entre el aumento de la morbilidad durante el embarazo e incrementos excesivos de la concentración plasmática del colesterol y triglicéridos. Por dicho motivo hemos revisado la relación entre las alteraciones lipídicas, la preeclampsia, la diabetes gestacional y el parto pretérmino. El control metabólico global de la embarazada mejoraría los resultados obstétricos, y la detección de alteraciones suprafisiológicas del perfil lipídico debería clasificar el embarazo en un nivel de riesgo superior, lo que comportaría un control más estricto
Lipids play an important role during pregnancy, and in this period major changes occur in lipoprotein metabolism. During the third trimester plasma cholesterol and triglyceride levels are substantially increased, returning to normal after delivery. Described associations between increased morbidity during pregnancy and excessive increases in plasma cholesterol and triglycerides. For this reason we have reviewed the relationship between lipid alterations, preeclampsia, gestational diabetes and preterm birth. The overall metabolic control can improve pregnancy outcomes, and the assessment of supraphysiological changes in lipid profile will classify pregnancy risk at a higher level, which would entail a stricter control
Subject(s)
Humans , Female , Pregnancy , Lipids/physiology , Pregnancy/physiology , Triglycerides/physiology , Cholesterol/physiology , Pregnancy Complications/physiopathology , Diabetes, Gestational/physiopathology , Pre-Eclampsia/physiopathologyABSTRACT
Lipids play an important role during pregnancy, and in this period major changes occur in lipoprotein metabolism. During the third trimester plasma cholesterol and triglyceride levels are substantially increased, returning to normal after delivery. Described associations between increased morbidity during pregnancy and excessive increases in plasma cholesterol and triglycerides. For this reason we have reviewed the relationship between lipid alterations, preeclampsia, gestational diabetes and preterm birth. The overall metabolic control can improve pregnancy outcomes, and the assessment of supraphysiological changes in lipid profile will classify pregnancy risk at a higher level, which would entail a stricter control.
