Window of Opportunity: Targeting ANGPTL4 Improves Triglyceride Levels in Maternal Obesity During Pregnancy

During pregnancy, maternal dyslipidemia is a physiological response that provides fuel and nutrients for both the placenta and the developing fetus (1). Although less appreciated than glucose and amino acids, maternal lipids promote fetal growth and are essential for normal development (2). During the first and second trimester of pregnancy, fat accumulates in maternal tissues, and by the third trimester of pregnancy, maternal hyperlipidemia, defined here as increased serum triglycerides (TG) and total cholesterol (TC), is significantly elevated due to moderately increased maternal insulin resistance and lipolysis of lipids in adipose tissues as well as attenuated lipid uptake by peripheral tissues (Fig. 1A). Both TG and TC are taken up by the placenta, and placental lipases can hydrolyze TG to free fatty acids for fetal-placental availability (3). It is important to note that while both TG and TC levels rise throughout pregnancy, the TG increase is disproportionately higher in comparison with other lipid fractions and subsequently falls precipitously to prepregnancy levels following delivery (4).