Abstract
BackgroundMaternal obesity is increasing worldwide but the consequences for maternal physiology and fetal growth are not fully understood.ObjectiveTo study whether changes in glucose and lipid metabolism during pregnancy differ between women with normal weight and overweight/obesity, and investigate which of these metabolic factors are associated with birthweight.DesignProspective, longitudinal study.SettingDepartment of Obstetrics, Oslo University Hospital, Rikshospitalet.Population1031 healthy pregnant women with singleton pregnancies.MethodsBlood samples from early and late pregnancy were analyzed for fasting glucose, insulin and lipids (total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides). Associations between metabolic factors and birthweight (z-scores) were explored by linear regression models. Main Outcome Measures: Group-dependent longitudinal changes in glucose and lipids and their association with birthweight (z-scores).ResultsCompared to women with normal weight (BMI < 25), women with overweight (BMI 25–29.9) and obesity (BMI > 30) had significantly higher fasting glucose (4.54, 4.68 and 4.84 mmol/l), insulin (23, 33 and 50 pmol/l), total cholesterol (4.85, 4.99 and 5.14 mmol/l), LDL-C (2.49, 2.66 and 2.88 mmol/l) and triglycerides (1.10, 1.28 and 1.57 mmol/l), but lower HDL-C (1.86, 1.75 and 1.55 mmol/l). BMI (B 0.05, 95% CI 0.03–0.06, p<0.001), gestational weight gain (GWG) (B 0.06, 0.05–0.08, p<0.001) and an increase in fasting glucose (B 0.30, 0.16–0.43, p<0.001) were positively associated with birthweight, whereas a decrease in HDL-C (B -0.72, -0.96- -0.53, p<0.001) had a negative association with birthweight.ConclusionsOverweight/obesity was associated with an unfavorable metabolic profile in early pregnancy which was associated with increased birthweight. However, modifiable factors like gestational weight gain and an increase in fasting glucose were identified and can be targeted for interventions.
Highlights
The intrauterine environment in which a fetus develops has increasingly been recognized as a determinant of pregnancy outcome at birth, but of future health [1]
Pregnancy is characterized by physiological adaptations in weight, glucose and lipid metabolism to ensure that the increasing nutritional demands of the mother, the placenta and the fetus are met
As the human fetus is highly dependent on glucose derived from the maternal circulation for growth and development, glucose homeostasis is maintained by increased hepatic glucose production, reduced insulin sensitivity and increased insulin production [3, 4]
Summary
The intrauterine environment in which a fetus develops has increasingly been recognized as a determinant of pregnancy outcome at birth, but of future health [1]. Pregnancy is characterized by physiological adaptations in weight, glucose and lipid metabolism to ensure that the increasing nutritional demands of the mother, the placenta and the fetus are met. Gestational weight gain (GWG) includes growth of the fetus, placenta and uterus, increase in maternal plasma volume and accumulation of maternal fat mass, adding up to an average of 12.5 kg [2]. High maternal body mass index (BMI), commonly used as a proxy for excess body fat, is consistently associated with increased risk of most pregnancy complications and long term outcomes for mother and child [5, 6]. We have previously shown how maternal BMI influences fetal growth measured as birthweight, intrauterine growth and percentage fat estimated by DXA in newborns, both directly as well as through increasing placental weight [9,10,11,12,13]. Maternal obesity is increasing worldwide but the consequences for maternal physiology and fetal growth are not fully understood
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