Associations of body composition and physical fitness with gestational diabetes and cardiovascular health in pregnancy: Results from the HealthyMoms trial

Emmie Söderström,Francisco B. Ortega,Pontus Henriksson,Victoria Snekkenes,Marja H. Leppänen,Marie Löf,Johanna Sandborg,Marie Blomberg

doi:10.1038/s41387-021-00158-z

Abstract

The aim of this study was to examine associations of body composition (fat mass index, % fat mass, fat-free mass index, body mass index) and physical fitness (cardiorespiratory fitness and handgrip strength) with gestational diabetes and cardiovascular health in early pregnancy. This cross-sectional study utilized baseline data (n = 303) collected in early pregnancy from the HealthyMoms trial. Body composition was measured using air-displacement plethysmography, cardiorespiratory fitness was assessed by means of the 6-min walk test and handgrip strength using a dynamometer. Logistic regression was used to estimate odds ratios (ORs) for gestational diabetes as well as high (defined as 1 SD above the mean) blood pressure, homeostatic model assessment for insulin resistance (HOMA-IR), and metabolic syndrome score (MetS score) per 1 SD increase in body composition and fitness variables. Fat mass index, % fat mass and body mass index were all strongly associated with gestational diabetes (ORs: 1.72–2.14, P ≤ 0.003), HOMA-IR (ORs: 3.01–3.80, P < 0.001), blood pressure (ORs: 1.81–2.05, P < 0.001) and MetS score (ORs: 3.29–3.71, P < 0.001). Associations with fat-free mass index were considerably weaker (ORs: 1.26–1.82, P = 0.001–0.15) and were strongly attenuated after adjustments for fat mass index (ORs: 0.88–1.54, P = 0.039–0.68). Finally, greater cardiorespiratory fitness was associated with lower risk of high HOMA-IR and MetS score (ORs: 0.57–0.63, P ≤ 0.004) although these associations were attenuated when accounting for fat mass index (ORs: 1.08-1.11, P ≥ 0.61). In conclusion, accurately measured fat mass index or % fat mass were strongly associated with gestational diabetes risk and markers of cardiovascular health although associations were not stronger than the corresponding ones for body mass index. Fat-free mass index had only weak associations with gestational diabetes and cardiovascular health which support that the focus during clinical care would be on excess fat mass and not fat-free mass.

Highlights

Pregnancy induces significant changes to the cardiovascular system[1] and evidence demonstrates that the Nutrition and DiabetesHenriksson et al Nutrition and Diabetes (2021)11:16 hypertension later in life[7]
Associations with Fat mass index (FMI) were generally unaffected by the mutual adjustment for fat-free mass index (FFMI) and physical fitness
Higher FFMI was statistically significantly associated with higher glucose, homeostatic model assessment for insulin resistance (HOMA-IR), systolic and diastolic blood pressure and metabolic syndrome (MetS) score in the unadjusted and partially adjusted model, associations were weaker than the corresponding associations for BMI, FMI and % fat mass (FM)

Summary

Introduction

Pregnancy induces significant changes to the cardiovascular system[1] and evidence demonstrates that the Nutrition and DiabetesHenriksson et al Nutrition and Diabetes (2021)11:16 hypertension later in life[7]. Obesity is a strong risk factor for gestational diabetes and other cardiovascular risk factors such as gestational hypertension and preeclampsia[11], categorization of obesity is based on BMI which is a relatively poor marker of body fatness in pregnancy[12]. Little is known whether the FFM of the body weight is related to cardiovascular health and the few previous studies have shown conflicting results[15,17]. It is not fully examined whether a state-of-the art body composition measure would convey cardiovascular health better than BMI which is widely used and widely criticized[18]

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