Normalizing Metabolism in Diabetic Pregnancy: Lipids

Further Research

The current evidence suggests a potential role for abnormal maternal lipid metabolism in promoting excess fetal growth and adiposity but does not prove causality. Prior to embarking on the routine use of any of these treatments, a number of further investigations need to be undertaken to fill major evidence gaps:

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  The epidemiology and associations of maternal lipids with fetal outcomes needs expansion, particularly in type 2 diabetes where data are currently based on very small numbers.
  
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  Systematic exploration of the impact of coexistent maternal factors such as obesity with diabetes on maternal lipids.
  
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  Closer examination of maternal lipids, placental lipid handling, and infant adiposity in women with familial lipid syndromes may well shed light on underlying mechanisms and whether lipids are truly associated with adverse pregnancy outcomes.
  
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  Almost all lipid studies have been undertaken on fasting blood samples: examination of whether postprandial maternal hypertriglyceridemia and chylomicronemia have an association with fetal growth as has been found with postprandial glucose.
  
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  Consideration of gestational age at the time of measurement of lipids needs further exploration. Early pregnancy measurement may give a better prognostic indication for later pregnancy complications.
  
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  Further animal studies, particularly in primate models, assessing the fetal effects of the pharmacological options.
  
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  Many of the therapies mentioned above have potential to alter not only maternal metabolism but placental metabolism and this should be investigated in greater detail.
  
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  Carefully designed interventional studies aimed at modifying maternal lipid levels in high-risk women. The most obvious pharmacological method to use initially would be omega-3 fatty acid supplements as these have been found to be relatively safe in pregnancy. The targets for maternal lipids in such trials would need to be based on large epidemiological studies examining maternal lipids and pregnancy outcomes in a continuous manner.
  

As in all pregnancy-related trials, safety of potential treatments, both for mother and baby, would be of paramount importance.