Low early-pregnancy serum lipoprotein(a) as an independent associated factor for gestational diabetes mellitus: a retrospective cohort study.

BACKGROUND

Dyslipidemia plays a significant role in the pathogenesis of gestational diabetes mellitus (GDM). However, the association between lipoprotein(a) (Lp(a)), a known predictor of cardiovascular disease, and GDM remains unclear. This study aimed to investigate the association between serum Lp(a) levels within the first 20 weeks of gestation and the subsequent risk of developing GDM.

METHODS

We conducted a retrospective cohort study of 14,527 pregnant women between September 2021 and January 2024. Using propensity score matching (PSM), 922 women with GDM were matched with 922 women with normal glucose tolerance (NGT). Lp(a) levels measured within the first 20 gestational weeks were compared between the two groups. A logistic regression model was employed to assess the association between Lp(a) levels and the later development of GDM. Additionally, restricted cubic spline regression models were applied to examine whether a nonlinear relationship existed between Lp(a) and GDM risk. Finally, sensitivity analyses across subgroups were conducted to assess the robustness of the findings.

RESULTS

Serum Lp(a) levels within the first 20 weeks of gestation were significantly lower in the GDM group compared to the NGT group (p = 0.013). After adjustment for potential confounders, compared to the group with Lp(a) ≥300 mg/L, those with Lp(a) levels of 50-300 mg/L and ≤50 mg/L exhibited a higher risk of developing GDM, with adjusted odds ratios of 1.354 (95% CI: 1.059-1.732; p = 0.016) and 1.454 (95% CI: 1.073-1.970; p = 0.016), respectively. Subgroup analysis indicated that maternal age, pre-pregnancy body mass index (BMI) and gestational weeks of Lp(a) measurement did not significantly influence the association between Lp(a) levels and GDM.

CONCLUSION

Low Lp(a) levels within the first 20 weeks of gestation were associated with the subsequent development of GDM, independent of maternal age and pre-pregnancy BMI.