Key result
High total cholesterol at 7 weeks gestation linked to ~330% greater early pregnancy loss risk.
Why the study?
Although dyslipidemia has been linked to adverse pregnancy outcomes, how variations in lipid levels during the first trimester might influence early pregnancy loss remained unclear.
Do elevated cholesterol levels during the first trimester increase the risk of early pregnancy loss in pregnant women?
Cohort (n=1,102)
No
Do elevated cholesterol levels during the first trimester increase the risk of early pregnancy loss in pregnant women?
Odds Ratio: 4.3 (95% CI 1.87–9.93)
p-value: p=<0.01
Elevated cholesterol levels during the first trimester are associated with an increased risk of early pregnancy loss, highlighting the potential importance of lipid monitoring during and before pregnancy.
May inform early EPL risk assessment; hypothesis-generating and requires prospective validation before any practice change.
PURPOSE: Dyslipidemia has been linked to adverse pregnancy outcomes in observational studies. This study aimed to explore how variations in lipid levels during the first trimester might influence early pregnancy loss (EPL). METHODS: Blood samples from pregnant women were analyzed to examine the relationship between EPL and lipid metabolism using logistic regression and restricted cubic splines (RCS). Sensitivity analysis was conducted to verify the robustness of the results. RESULTS: Elevated low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) levels at most times of 4-9 weeks of gestation were associated with a higher risk of EPL, regardless of whether the control group was successful pregnancy or live birth. Specifically, taking the successful pregnancy group as a control example, increased EPL risks were observed in the highest quartile of plasma TC at 4 weeks (OR = 2.18, 95%: 1.14-4.21) and 7 weeks (OR = 4.30, 95%: 1.87-9.93) of pregnancy. Significant EPL risks were also noted in the third (Q3) and fourth (Q4) quartiles of LDL-C at 4 weeks (Q3, OR = 2.98, 95%: 1.47-6.08; Q4, OR = 2.66, 95%: 1.27-5.55) and 7 weeks (Q3, OR = 3.12, 95%: 1.44-6.73; Q4, OR = 5.17, 95%: 2.14-12.49). High TC levels (> 3.25-3.78 mmol/L) and high LDL-C levels (> 1.92-2.04 mmol/L) were linked to an increased risk of EPL compared to lower levels of TC (≤ 2.91-3.05 mmol/L) and LDL-C (≤ 1.64-1.75 mmol/L).RCS analysis further confirmed this finding that plasma TC and LDL-C levels at 4 and 7 weeks of gestation may have a linear relationship with the risk of EPL. By the way, triglyceride levels at 6 and 8 weeks of gestation were associated with a higher risk of EPL, whereas high-density lipoprotein cholesterol (HDL-C) levels at 5 and 9 weeks of gestation have a completely opposite relationship with EPL risk. CONCLUSIONS: Elevated cholesterol levels during the first trimester are associated with an increased risk of early pregnancy loss, emphasizing the need for lipid monitoring during pregnancy and even before pregnancy.
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Zhang et al. (2025) conducted a cohort in Early pregnancy loss (n=1,102). Elevated total cholesterol and LDL-C vs. Lower cholesterol levels was evaluated on Early pregnancy loss (EPL) associated with highest vs lowest quartile of total cholesterol at 7 weeks (OR 4.30, 95% CI 1.87-9.93, p=<0.01). Elevated total cholesterol in the highest quartile at 7 weeks of gestation was associated with a significantly increased risk of early pregnancy loss compared to the lowest quartile (OR 4.30).
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