6956 Changes in LDL-Cholesterol from 6 Weeks to 12 Months Postpartum in Women with Recent Gestational Diabetes
Authors: Tan Emily C , Dias Jennifer M , Nicklas Jacinda M , Seely Ellen W 
Published: October 2024

Abstract
Disclosure: E.C. Tan: None. J.M. Dias: None. J.M. Nicklas: None. E.W. Seely: None.
Background: During pregnancy, maternal lipids increase to support fetal growth and return to baseline in the year following delivery. High LDL is associated with increased risk of developing cardiovascular disease, which warrants lifestyle intervention and potentially medication. In patients with recent gestational diabetes mellitus (GDM), the trajectory of maternal lipids in the 1 year after delivery is not well-known. As both ADA and ACOG recommend an OGTT within 4-12 weeks postpartum (PP) for patients with recent GDM, there is an opportunity to obtain a lipid panel as many women do not have continuing care beyond this visit. In this study, we sought to characterize changes in lipid levels in women with recent GDM especially in those with LDL ≥160 mg/dL (“high LDL” per AHA) between 6 weeks and 12 months PP. Methods: This study was a secondary analysis of the Balance after Baby intervention study, a prospective RCT of a web-based lifestyle program for women with recent GDM (ClinicalTrials.gov identifier: NCT02744300). Women with diabetes at their 6-week OGTT were excluded and 181 participants were randomized. Body weights and fasting lipids were also determined at 6 weeks and 12 months PP. LDL was calculated by the Friedewald equation. Paired t-tests were performed to compare lipids at 6 weeks versus 12 months. Bivariate correlations were determined using Pearson’s correlation coefficient. Results: Paired lipid levels were available for 121 subjects (mean age, SD 33.1±5.4 years, 47.1% White/21.5% Black/31.4% Hispanic). At 6 weeks PP, lipid levels were: mean±SD, LDL 115±30 mg/dL; HDL 57±17 mg/dL; triglycerides (TG) 116±62 mg/dL; total cholesterol (TC) 195±44 mg/dL. No subject had TG &gt;400 mg/dL. There was no significant effect of the intervention on weight or metabolic measures at 12 months. All lipid profile components decreased significantly at 12 months PP (ΔLDL: -11.9%; ΔHDL: -10.7%; ΔTC: -11.2%; all p&lt;0.001; ΔTG: -9.7%; p&lt;0.05). Only change in LDL had a positive correlation with weight change between 6 weeks and 12 months PP (r2=.330, p&lt;0.001). 10.7% (N=13) of women had LDL ≥160 mg/dL at 6 weeks PP. In this group, lipids were: mean±SD, LDL 195±30 mg/dL; HDL 58±11 mg/dL; TG 143±60 mg/dL; TC 282±35 mg/dL. At 12 months PP, LDL, HDL, and TC fell significantly (ΔLDL: -21.2%; ΔHDL: -12.0%; ΔTC: -17.6%; p&lt;0.001). 46.2% (N=6) of these subjects fell to LDL &lt;160 mg/dL at 12 months PP. Only one participant with LDL &lt;160 mg/dL (159 mg/dL) at 6 weeks PP increased to LDL ≥160 mg/dL (188 mg/dL) at 12 months PP. High LDL at 6 weeks was positively correlated with high LDL at 12 months (r2=.660, p&lt;0.001). Conclusion: Lipid profile components fell significantly in the 1 year after delivery in women with recent GDM. Given that fall in weight was correlated with fall in LDL, these findings emphasize the importance of promoting weight loss in the 1 year PP. Women with LDL &gt;160 mg/dL at 6 weeks PP should be targeted for follow-up LDL at 1 year PP.
Presentation: 6/3/2024