Dynamic changes in blood lipid levels and their associations with hypertensive disorders of pregnancy in twin pregnancy: A retrospective study

•Elevated TG and LDL-c were associated with PE. •A significant increase in TG or decrease in HDL-c were more prone to PE. •More attention should be paid to underweight, overweight, and primipara women. Background Little knowledge on the association of blood lipid levels with hypertensive disorders of pregnancy (HDP) in twin pregnancy. Objective To investigate the association of blood lipid levels with HDP in twin pregnancy. Methods This is a retrospective study in the Beijing Birth Cohort on patients followed between January 2014 and November 2021. A total of 2628 women pregnant with twins were included and divided into HDP (n = 565) and normal blood pressure (NBP, n = 2063) groups. HDP subtypes included gestational hypertension (GH, n = 190) and preeclampsia (PE, n = 375). Dynamic changes in blood lipid profiles and their associations with HDP were assessed. Results Compared to NBP group, higher triglyceride (TG) and low-density lipoprotein cholesterol (LDL-c) in the first (T1) and second trimesters (T2) existed in women with PE. In addition, TG increased significantly from T1 to T2, and HDL-c decreased significantly since T2 in women with PE, especially in women with early-onset PE and severe PE. Elevated TG and LDL-c were associated with HDP, mainly PE. In a subgroup analysis, higher TG or LDL-c increased the risk of HDP for underweight, overweight and primipara women. Conclusions In twin pregnancy, women with PE had higher TG and LDL-c, and elevatedTG and LDL-c were associated with PE. A significant increase in TG or decrease in HDL-cwere more prone to PE, especially early-onset PE and severe PE. It is helpful to monitorblood lipid levels in women pregnant with twins, especially in underweight, overweight, and primipara women. Little knowledge on the association of blood lipid levels with hypertensive disorders of pregnancy (HDP) in twin pregnancy. To investigate the association of blood lipid levels with HDP in twin pregnancy. This is a retrospective study in the Beijing Birth Cohort on patients followed between January 2014 and November 2021. A total of 2628 women pregnant with twins were included and divided into HDP (n = 565) and normal blood pressure (NBP, n = 2063) groups. HDP subtypes included gestational hypertension (GH, n = 190) and preeclampsia (PE, n = 375). Dynamic changes in blood lipid profiles and their associations with HDP were assessed. Compared to NBP group, higher triglyceride (TG) and low-density lipoprotein cholesterol (LDL-c) in the first (T1) and second trimesters (T2) existed in women with PE. In addition, TG increased significantly from T1 to T2, and HDL-c decreased significantly since T2 in women with PE, especially in women with early-onset PE and severe PE. Elevated TG and LDL-c were associated with HDP, mainly PE. In a subgroup analysis, higher TG or LDL-c increased the risk of HDP for underweight, overweight and primipara women. In twin pregnancy, women with PE had higher TG and LDL-c, and elevatedTG and LDL-c were associated with PE. A significant increase in TG or decrease in HDL-cwere more prone to PE, especially early-onset PE and severe PE. It is helpful to monitorblood lipid levels in women pregnant with twins, especially in underweight, overweight, and primipara women.