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Convergence in insulin resistance between very severely obese and lean women at the end of pregnancy.

Forbes S, Barr SM, Reynolds RM, Semple S, Gray C, Andrew R, Denison FC, Walker BR, Norman JE - Diabetologia (2015)

Bottom Line: Disrupted intermediary metabolism may contribute to the adverse pregnancy outcomes in women with very severe obesity.Pregnancies complicated by obesity demonstrate attenuation in weight gain and insulin resistance compared with pregnancies in lean women.When targeting maternal metabolism to treat adverse pregnancy outcomes, therapeutic intervention may be most effective applied early in pregnancy.

View Article: PubMed Central - PubMed

Affiliation: Tommy's Centre for Fetal and Maternal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK. Shareen.Forbes@ed.ac.uk.

ABSTRACT

Aims: Disrupted intermediary metabolism may contribute to the adverse pregnancy outcomes in women with very severe obesity. Our aim was to study metabolism in such pregnancies.

Methods: We recruited a longitudinal cohort of very severely obese (n = 190) and lean (n = 118) glucose-tolerant women for anthropometric and metabolic measurements at early, mid and late gestation and postpartum. In case-control studies of very severely obese and lean women we measured glucose and glycerol turnover during low- and high-dose hyperinsulinaemic-euglycaemic clamps (HEC) at early and late pregnancy and in non-pregnant women (each n = 6-9) and body fat distribution by MRI in late pregnancy (n = 10/group).

Results: Although greater glucose, insulin, NEFA and insulin resistance (HOMA-IR), and greater weight and % fat mass (FM) was observed in very severely obese vs lean participants, the degree of worsening was attenuated in the very severely obese individuals with advancing gestation, with no difference in triacylglycerol (TG) concentrations between very severely obese and lean women at term. Enhanced glycerol production was observed in early pregnancy only in very severely obese individuals, with similar intrahepatic FM in very severely obese vs lean women by late gestation. Offspring from obese mothers were heavier (p = 0.04).

Conclusions/interpretation: Pregnancies complicated by obesity demonstrate attenuation in weight gain and insulin resistance compared with pregnancies in lean women. Increased glycerol production is confined to obese women in early pregnancy and obese and lean individuals have similar intrahepatic FM by term. When targeting maternal metabolism to treat adverse pregnancy outcomes, therapeutic intervention may be most effective applied early in pregnancy.

No MeSH data available.


Related in: MedlinePlus

Weight and metabolic data of NGT obese and lean control participants. Data at early (~16 weeks [w]) (n = 190, obese [white bars], n = 118 lean [black bars]), mid (~28 weeks) and late (~36 weeks) gestation and postpartum. (a) Weight, (b) glucose, (c) NEFA, (d) TG, (e) insulin and (f) HOMA-IR. Median ± IQR demonstrated at each visit. Repeated ANOVA analyses were performed from the three visits during pregnancy and again on the four visits including the postpartum (PP) visit. *p < 0.05, **p < 0.01, ***p < 0.001
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Fig1: Weight and metabolic data of NGT obese and lean control participants. Data at early (~16 weeks [w]) (n = 190, obese [white bars], n = 118 lean [black bars]), mid (~28 weeks) and late (~36 weeks) gestation and postpartum. (a) Weight, (b) glucose, (c) NEFA, (d) TG, (e) insulin and (f) HOMA-IR. Median ± IQR demonstrated at each visit. Repeated ANOVA analyses were performed from the three visits during pregnancy and again on the four visits including the postpartum (PP) visit. *p < 0.05, **p < 0.01, ***p < 0.001

Mentions: In the longitudinal study, initial data revealed a decrease in circulating glucose in lean women only from early to late pregnancy (Fig. 1). To explore this, further groups of women were recruited in nested case–control studies, including: (1) lean and very severely obese pregnant and non-pregnant women, who underwent HEC studies with stable isotope tracer infusions at early (~19 weeks) or late (~36 weeks) gestation or when not pregnant; and (2) groups of lean and obese pregnant women who underwent MRI/MRS analysis of subcutaneous, visceral, intramuscular and intrahepatic fat at late gestation (Table 1). Exclusions were as in the longitudinal cohort study.Fig. 1


Convergence in insulin resistance between very severely obese and lean women at the end of pregnancy.

Forbes S, Barr SM, Reynolds RM, Semple S, Gray C, Andrew R, Denison FC, Walker BR, Norman JE - Diabetologia (2015)

Weight and metabolic data of NGT obese and lean control participants. Data at early (~16 weeks [w]) (n = 190, obese [white bars], n = 118 lean [black bars]), mid (~28 weeks) and late (~36 weeks) gestation and postpartum. (a) Weight, (b) glucose, (c) NEFA, (d) TG, (e) insulin and (f) HOMA-IR. Median ± IQR demonstrated at each visit. Repeated ANOVA analyses were performed from the three visits during pregnancy and again on the four visits including the postpartum (PP) visit. *p < 0.05, **p < 0.01, ***p < 0.001
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4589551&req=5

Fig1: Weight and metabolic data of NGT obese and lean control participants. Data at early (~16 weeks [w]) (n = 190, obese [white bars], n = 118 lean [black bars]), mid (~28 weeks) and late (~36 weeks) gestation and postpartum. (a) Weight, (b) glucose, (c) NEFA, (d) TG, (e) insulin and (f) HOMA-IR. Median ± IQR demonstrated at each visit. Repeated ANOVA analyses were performed from the three visits during pregnancy and again on the four visits including the postpartum (PP) visit. *p < 0.05, **p < 0.01, ***p < 0.001
Mentions: In the longitudinal study, initial data revealed a decrease in circulating glucose in lean women only from early to late pregnancy (Fig. 1). To explore this, further groups of women were recruited in nested case–control studies, including: (1) lean and very severely obese pregnant and non-pregnant women, who underwent HEC studies with stable isotope tracer infusions at early (~19 weeks) or late (~36 weeks) gestation or when not pregnant; and (2) groups of lean and obese pregnant women who underwent MRI/MRS analysis of subcutaneous, visceral, intramuscular and intrahepatic fat at late gestation (Table 1). Exclusions were as in the longitudinal cohort study.Fig. 1

Bottom Line: Disrupted intermediary metabolism may contribute to the adverse pregnancy outcomes in women with very severe obesity.Pregnancies complicated by obesity demonstrate attenuation in weight gain and insulin resistance compared with pregnancies in lean women.When targeting maternal metabolism to treat adverse pregnancy outcomes, therapeutic intervention may be most effective applied early in pregnancy.

View Article: PubMed Central - PubMed

Affiliation: Tommy's Centre for Fetal and Maternal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK. Shareen.Forbes@ed.ac.uk.

ABSTRACT

Aims: Disrupted intermediary metabolism may contribute to the adverse pregnancy outcomes in women with very severe obesity. Our aim was to study metabolism in such pregnancies.

Methods: We recruited a longitudinal cohort of very severely obese (n = 190) and lean (n = 118) glucose-tolerant women for anthropometric and metabolic measurements at early, mid and late gestation and postpartum. In case-control studies of very severely obese and lean women we measured glucose and glycerol turnover during low- and high-dose hyperinsulinaemic-euglycaemic clamps (HEC) at early and late pregnancy and in non-pregnant women (each n = 6-9) and body fat distribution by MRI in late pregnancy (n = 10/group).

Results: Although greater glucose, insulin, NEFA and insulin resistance (HOMA-IR), and greater weight and % fat mass (FM) was observed in very severely obese vs lean participants, the degree of worsening was attenuated in the very severely obese individuals with advancing gestation, with no difference in triacylglycerol (TG) concentrations between very severely obese and lean women at term. Enhanced glycerol production was observed in early pregnancy only in very severely obese individuals, with similar intrahepatic FM in very severely obese vs lean women by late gestation. Offspring from obese mothers were heavier (p = 0.04).

Conclusions/interpretation: Pregnancies complicated by obesity demonstrate attenuation in weight gain and insulin resistance compared with pregnancies in lean women. Increased glycerol production is confined to obese women in early pregnancy and obese and lean individuals have similar intrahepatic FM by term. When targeting maternal metabolism to treat adverse pregnancy outcomes, therapeutic intervention may be most effective applied early in pregnancy.

No MeSH data available.


Related in: MedlinePlus