Abstract
Maternal obesity is associated with adverse offspring outcomes. Inflammation and deficiency of anti-inflammatory nutrients like omega(n)-3 polyunsaturated fatty acids (PUFA) may contribute to these associations. Fetal supply of n-3 PUFA is dependent on maternal levels and studies have suggested that improved offspring outcomes are associated with higher maternal intake. However, little is known about how maternal obesity affects the response to n-3 supplementation during pregnancy. We sought to determine (1) the associations of obesity with PUFA concentrations and (2) if the systemic response to n-3 supplementation differs by body mass index (BMI). This was a secondary analysis of 556 participants (46% lean, 28% obese) in the Maternal-Fetal Medicine Units Network trial of n-3 (Docosahexaenoic acid (DHA) + Eicosapentaenoic acid (EPA)) supplementation, in which participants had 2g/day of n-3 (n = 278) or placebo (n = 278) from 19 to 22 weeks until delivery. At baseline, obese women had higher plasma n-6 arachidonic acid concentrations (β: 0.96% total fatty acids; 95% Confidence Interval (CI): 0.13, 1.79) and n-6/n-3 ratio (β: 0.26 unit; 95% CI: 0.05, 0.48) compared to lean women. In the adjusted analysis, women in all BMI groups had higher n-3 concentrations following supplementation, although obese women had attenuated changes (β = −2.04%, CI: −3.19, −0.90, interaction p = 0.000) compared to lean women, resulting in a 50% difference in the effect size. Similarly, obese women also had an attenuated reduction (β = 0.94 units, CI: 0.40, 1.47, interaction p = 0.046) in the n-6/n-3 ratio (marker of inflammatory status), which was 65% lower compared to lean women. Obesity is associated with higher inflammation and with an attenuated response to n-3 supplementation in pregnancy.
Highlights
polyunsaturated fatty acids (PUFA) variables that were examined in our analysis were: total n-3 PUFA, Docosahexaenoic acid (DHA)+eicosapentaenoic acid (EPA), total n-6 PUFA, arachidonic acid (AA), n-6/n-3 PUFA ratio, and AA/DHA+EPA ratio. We evaluated these variables because they reflected supplementation (DHA+EPA), the total load of anti-inflammatory PUFA (Total n-3 PUFA), and pro-inflammatory PUFA (Total n-6 PUFA)
For Aim 1, we investigated the associations between body mass index (BMI) and baseline PUFA concentrations using linear regression analyses controlling for relevant confounders
To control for confounding variables, we examined the effect of supplementation on PUFA concentrations in all participants using linear regression analyses adjusting for maternal sociodemographics, fish consumption, BMI as a continuous variable, and duration of supplementation
Summary
Over 60% of women in the United States are overweight or obese prior to pregnancy [1].Maternal obesity is associated with increased risk of adverse maternal and infant outcomes including preterm delivery, macrosomia, and adverse child metabolic and neurodevelopmental outcomes [2,3].The metabolic environment of an obese pregnant woman is characterized by chronic dysregulated inflammation and oxidative stress, which may play a role in the developmental programming of these adverse outcomes [4,5,6,7,8].Obesity-related inflammation can originate from intrinsic and extrinsic (dietary) sources.Intrinsically, excessive accretion of adipose tissue and concurrent macrophage activation leadNutrients 2018, 10, 1908; doi:10.3390/nu10121908 www.mdpi.com/journal/nutrientsNutrients 2018, 10, 1908 to increased expression of pro-inflammatory cytokines [4]. The metabolic environment of an obese pregnant woman is characterized by chronic dysregulated inflammation and oxidative stress, which may play a role in the developmental programming of these adverse outcomes [4,5,6,7,8]. Obesity-related inflammation can originate from intrinsic and extrinsic (dietary) sources. Women with a higher pre-pregnancy body mass index (BMI) were found to have poorer dietary quality, characterized by a higher intake of trans and saturated fats [9]. This dietary profile may further contribute to the pro-inflammatory milieu in obese pregnancies
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