Introduction: Preterm birth is one of the major contributors to neonatal morbidity and mortality worldwide, with increasing attention towards metabolic factors which influence pregnancy outcomes. Maternal lipid metabolism undergoes major physiological changes during pregnancy; Elevated cholesterol levels may affect the placental function and fetal development adversely. Materials and Methods: An observational prospective study was conducted among 200 antenatal females attending the obstetric department at the Government Thoothukudi Medical College Hospital between August 2022 and December 2024. The pregnant females aged between 19–35 years with singleton uncomplicated pregnancies at 12–26 weeks of gestation were enrolled in the study after obtaining the informed consent. Fasting venous blood samples were collected for estimating the serum cholesterol using standardized biochemical techniques. Results: The incidence of preterm delivery was found to be 9.5%. Mothers with serum cholesterol levels exceeding 300 mg/dL showed a higher proportion of preterm births (69.23%) compared to those with lower cholesterol levels (p <0.001). The Mean maternal cholesterol levels were significantly higher in the preterm delivery (277.26 ± 68.90 mg/dL) than in the term delivery group (223.23 ± 43.20 mg/dL). Elevated cholesterol was also linked with a higher proportion of low birth weight infants and increased NICU admissions, while maternal age, gestational age and parity were not significantly associated with the outcome of the delivery. Conclusion: Markedly raised maternal serum cholesterol levels during the early pregnancy may serve as a major predictor of preterm delivery and the adverse neonatal outcomes. Early lipid screening could help in finding the high-risk pregnancies and improving the antenatal risk stratification.
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