Published online October 1, 2007
PEDIATRICS Vol. 120 No. 4 October 2007, pp. 723-733 (doi:10.1542/peds.2006-1939)

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ARTICLE

Adverse Birth Outcome Among Mothers With Low Serum Cholesterol

Robin J. Edison, MD, MPH^a, Kate Berg, PhD^a, Alan Remaley, MD^b, Richard Kelley, MD, PhD^c, Charles Rotimi, PhD^d, Roger E. Stevenson, MD^e and Maximilian Muenke, MD^a

^a Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
^b National Institutes of Health Clinical Center, Bethesda, Maryland
^c Kennedy Krieger Institute, Baltimore, Maryland
^d National Human Genome Research Center, Howard University, Washington, DC
^e Greenwood Genetic Center, Greenwood, South Carolina

OBJECTIVE. The objective of this study was to assess whether low maternal serum cholesterol during pregnancy is associated with preterm delivery, impaired fetal growth, or congenital anomalies in women without identified major risk factors for adverse pregnancy outcome.

METHODS. Mother-infant pairs were retrospectively ascertained from among a cohort of 9938 women who were referred to South Carolina prenatal clinics for routine second-trimester serum screening. Banked sera were assayed for total cholesterol; <10th percentile of assayed values (159 mg/dL at mean gestational age of 17.6 weeks) defined a "low total cholesterol" prenatal risk category. Eligible women were aged 21 to 34 years and nonsmoking and did not have diabetes; neonates were liveborn after singleton gestations. Total cholesterol values of eligible mothers were adjusted for gestational age at screening before risk group assignment. The study population included 118 women with low total cholesterol and 940 women with higher total cholesterol. Primary analyses used multivariate regression models to compare rates of preterm delivery, fetal growth parameters, and congenital anomalies between women with low total cholesterol and control subjects with mid–total cholesterol values >10th percentile but <90th percentile.

RESULTS. Prevalence of preterm delivery among mothers with low total cholesterol was 12.7%, compared with 5.0% among control subjects with mid–total cholesterol. The association of low maternal serum cholesterol with preterm birth was observed only among white mothers. Term infants of mothers with low total cholesterol weighed on average 150 g less than those who were born to control mothers. A trend of increased microcephaly risk among neonates of mothers with low total cholesterol was found. Low maternal serum cholesterol was unassociated with risk for congenital anomalies.

CONCLUSIONS. Total serum cholesterol <10th population percentile was strongly associated with preterm delivery among otherwise low-risk white mothers in this pilot study population. Term infants of mothers with low total cholesterol weighed less than control infants among both racial groups.

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Key Words: cholesterol • preterm birth • birth defects • congenital defects • birth weight • embryonic and fetal development • lipoproteins

Abbreviations: LDL-C—low-density lipoprotein cholesterol • TC—total cholesterol • IUGR—intrauterine growth restriction • LMSC—low maternal serum cholesterol • GA—gestational age • GGC—Greenwood Genetic Center • NIH—National Institutes of Health • OR—odds ratio • CI—confidence interval

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Accepted Mar 14, 2007.

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