Epidemiology
Low early-pregnancy Lp(a) independently predicts gestational diabetes in a 14,527-woman cohort (Front Endocrinol (Lausanne) 2026)
Original title: Low early-pregnancy serum lipoprotein(a) as an independent associated factor for gestational diabetes mellitus: a retrospective cohort study
This retrospective cohort study followed 14,527 pregnant women between September 2021 and January 2024, using propensity score matching to compare 922 women who developed gestational diabetes mellitus (GDM) with 922 women with normal glucose tolerance. Serum Lp(a) measured within the first 20 gestational weeks was significantly lower in the GDM group (P = 0.013). After adjustment for confounders, compared with women with Lp(a) of 300 mg/L or above, those with Lp(a) between 50 and 300 mg/L had an adjusted odds ratio for GDM of 1.354 (95% CI 1.059-1.732, P = 0.016), and those at or below 50 mg/L had an adjusted odds ratio of 1.454 (95% CI 1.073-1.970, P = 0.016); maternal age, pre-pregnancy BMI and gestational timing of measurement did not alter the association. This large, well-matched cohort positions low early-pregnancy Lp(a), rather than the more familiar high-Lp(a) cardiovascular risk, as an independent GDM risk marker.
Original abstract
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.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.