Dyslipidemia in early second trimester is mainly a feature of women with early onset pre-eclampsia

Objective To investigate whether hypertriglyceridemic dyslipidemia is a risk factor for either early or late onset pre-eclampsia. Design Prospective cohort study and nested case-control study. Setting Aker Hospital: a university hospital with all levels of obstetric care. Participants 2157 Caucasian pregnant women. Methods Blood samples were obtained from non-fasting subjects at 18 weeks of gestation. All samples were analysed for triglycerides, total-cholesterol, high density lipoproteins cholesterol and non-high density lipoproteins cholesterol. ApoB-100 were analysed in pre-eclamptic women and in 3:1 matched controls. The cohort data were analysed by multiple logistic regression and the case-control data by conditional logistic regression. Main outcome measures Adjusted odds ratios of early and late onset pre-eclampsia according to early second trimester serum concentration levels of lipids and ApoB-100. Results Eighteen women developed early onset pre-eclampsia and 53 women developed late onset pre-eclampsia. In the cohort model, women with triglycerides above 2.4 mmol/L had increased risk (OR 5. 1; 95% Cl 1.1-23.1) of early onset pre-eclampsia compared with those with triglycerides levels less than or equal to 1.5mmol/L. For women with high triglycerides: non-high density lipoproteins cholesterol ratios (> 90 centile) the OR (95% CI) for early onset pre-eclampsia was 7.1 (2.3-22.0) compared with those with low ratios (less than or equal to 50 centile). Similar associations were found in the case control model. We found no associations between plasma lipids and risk of late onset pre-eclampsia. Conclusions Hypertriglyceridemic dyslipidemia before 20 weeks of gestation is associated with the risk of developing early but not late onset pre-eclampsia, giving support to the contention that these two variants of the disease are at least partly pathogenically different.