A prospective and longitudinal study of plasma phospholipid saturated fatty acid profile in relation to cardiometabolic biomarkers and the risk of gestational diabetes

Abstract

Background: Data on saturated fatty acids (SFAs) in relation to metabolic function and glucose homeostasis remain controversial. Such data are lacking among pregnant women.

Objective: We prospectively investigated objectively measured individual and subclasses of plasma phospholipid SFAs throughout pregnancy in relation to cardiometabolic markers and gestational diabetes mellitus (GDM) risk.

Design: Within the National Institute of Child Health and Human Development Fetal Growth Studies-Singleton Cohort of 2802 singleton pregnancies, 107 GDM cases were ascertained via medical record review and matched to 214 non-GDM controls on age, race/ethnicity, and gestational week (GW) at blood collection. Individual plasma phospholipid SFA concentrations were repeatedly measured throughout pregnancy at GWs 10-14, 15-26, 23-31, and 33-39 and also grouped into subclasses of even- or odd-chain SFAs.

Results: From GW 10, even-chain SFA concentrations were significantly higher among women who later developed GDM, whereas odd-chain SFAs were significantly lower among GDM cases compared with controls. At GWs 10-14, the SFA palmitic acid (16:0) was positively associated with impaired insulin resistance and cardiometabolic markers and the risk of GDM [adjusted OR comparing the highest with the lowest quartile (aORQ4-Q1): 4.76; 95% CI: 1.72, 13.10; P-trend = 0.001]. In contrast, odd-chain SFAs were inversely related to the previously mentioned markers and GDM risk [aORQ4-Q1 for pentadecanoic acid (15:0): 0.32; 95% CI: 0.11, 0.92; P-trend = 0.025; for heptadecanoic acid (17:0): 0.20; 95% CI: 0.07, 0.58; P-trend = 0.003]. Women with high (median or greater) even-chain SFA concentrations and low (less than median) odd-chain SFAs had a 9.43-fold (95%: CI 3.26-, 27.30-fold) increased risk compared with women with low even-chain and high odd-chain SFA concentrations. Similar results were observed at GWs 15-26.

Conclusions: The study provided one of the first lines of evidence suggesting that circulating concentrations of SFAs varying by SFA chain length, as early as GWs 10-14, were significantly and differentially associated with subsequent risk of GDM. Our findings highlight the importance of assessing objectively measured, individual, and subclasses of SFAs to investigate their distinct biological and pathophysiologic roles in glucose homeostasis and cardiometabolic outcomes. This study was registered at www.clinicaltrials.gov as NCT00912132.

Figures

FIGURE 1

Longitudinal profiles of plasma even-chain and odd-chain SFAs throughout pregnancy according to gestational age intervals among women with and without GDM. Even-chain SFAs: sum of myristic acid (14:0), palmitic acid (16:0), and stearic acid (18:0); odd-chain SFAs: sum of pentadecanoic acid (15:0) and heptadecanoic acid (17:0). Values are mean percentages ± SEs. *P < 0.05, **P < 0.01, ***P < 0.001 for case-control comparisons obtained by linear mixed models with associated likelihood ratio tests accounting for matched case-control pairs at each gestational age interval. P-interaction between gestational weeks and GDM status was 0.042 for even-chain SFAs and <0.001 for odd-chain SFAs, obtained by likelihood ratio test. GDM, gestational diabetes mellitus.

FIGURE 2

Adjusted ORs (95% CIs) of subsequent GDM risk per a 1-SD increase in plasma phospholipid SFAs (%) at gestational weeks 10–14 and 15–26. The risk estimates were adjusted for age (years), gestational age at blood collection (weeks), parity (nulliparous or multiparous), family history of diabetes (yes or no), and prepregnancy BMI (kg/m2; <25.0, 25.0–29.9, 30.0–34.9, or 35.0–44.9). GDM, gestational diabetes mellitus.

FIGURE 3

Adjusted ORs (95% CIs) of subsequent GDM risk in association with plasma phospholipid even-chain and odd-chain phospholipid SFAs (%) at gestational weeks 10–14 and 15–26. The point estimates were adjusted for age (years), gestational age at blood collection (weeks), parity (nulliparous or multiparous), family history of diabetes (yes or no), and prepregnancy BMI (kg/m2; <25.0, 25.0–29.9, 30.0–34.9, or 35.0–44.9). GDM, gestational diabetes mellitus; High, concentrations above the median; Low, concentrations below the median.