Association between blood lipid levels and preeclampsia: a meta-analysis

Objective To quantitatively synthesize the association between maternal blood lipid levels and the risk of preeclampsia (PE), and to evaluate its potential clinical utility for risk stratification monitoring. Methods Relevant literature was retrieved from international databases (PubMed, Web of Science, the Cochrane Library, Embase) and Chinese databases (CNKI, Wanfang, VIP, SinoMed) up to March 2025. After screening, statistical analyses were conducted using RevMan 5.4.1 software. Heterogeneity was assessed using the Q -test and I 2 statistic. Fixed-effect or random-effect models were applied as appropriate. For continuous lipid indicators (HDL, LDL, TG, TC), effect sizes were expressed as standardized mean difference (SMD) with 95% confidence intervals (CI); for adverse pregnancy outcomes (binary variable), odds ratio (OR) with 95% CI was used. Sensitivity analyses were performed by sequentially excluding studies with the highest weights and by restricting to studies reporting BMI-adjusted estimates. Publication bias was evaluated using funnel plots and Egger's test. Results A total of 822 studies were initially retrieved, and 12 studies met the inclusion criteria. The meta-analysis showed that compared to controls, HDL levels were significantly lower in PE patients (SMD = −0.14, 95% CI: −0.18 to −0.10, P < 0.05), while LDL (SMD = 0.44, 95% CI: 0.32–0.55, P < 0.05), TG (SMD = 0.47, 95% CI: 0.36–0.59, P < 0.05), and TC (SMD = 0.24, 95% CI: 0.18–0.31, P < 0.05) were significantly elevated. Sensitivity analyses restricted to studies with BMI-adjusted estimates yielded consistent results with attenuated effect sizes (HDL: SMD = −0.09; LDL: SMD = 0.38; TG: SMD = 0.43; TC: SMD = 0.22). The incidence of adverse pregnancy outcomes was significantly higher in the PE group (OR = 3.90, 95% CI: 2.62–5.81, P < 0.00001). Conclusion Patients with PE exhibit significant alterations in blood lipid levels, which are associated with adverse pregnancy outcomes. These associations persist after adjusting for BMI, although effect sizes are modest. Blood lipid monitoring may serve as a clinical reference in PE management, but causal inference is precluded due to the observational nature of the included studies.