Lipid Metabolism in Pregnancy

Knopp, Robert H.; Bonet, Bartolomé; Zhu, Xuming

doi:10.1007/978-1-4612-1642-1_12

Cited by 31 publications

(39 citation statements)

References 223 publications

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“…Maternal plasma DHA content commonly declines during pregnancy (Al et al, 1995a;Otto et al, 1997;Matorras et al, 2001), particularly in later pregnancy (Knopp, 1991) when foetal requirements for LCPUFA are highest (Clandinin, 1999;Al et al, 2000). In the current study, this pattern was not observed in the control group, possibly because the initial maternal stores were higher than reported in other populations (Matorras et al, 2001).…”

Section: Discussioncontrasting

confidence: 65%

Effects of n-3 polyunsaturated fatty acid supplementation in pregnancy on maternal and fetal erythrocyte fatty acid composition

et al. 2004

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Objective: The aim of this study was to assess the effects of fish oil supplementation in pregnancy on maternal erythrocyte fatty acid composition at different stages of pregnancy and in the post-partum period, and on neonatal erythrocyte fatty acid composition. Design: A double-blind, randomised, placebo-controlled study. Setting: Subiaco, Western Australia. Subjects: In all, 98 women booked for delivery at St John of God Hospital, Subiaco, were recruited from private rooms of obstetricians. In total, 83 women and their healthy full-term babies completed the study. Intervention: Women received either 4 g of fish oil (n ¼ 52) (56% docosahexaenoic acid (DHA) and 28% eicosapentaenoic acid (EPA) or placebo (olive oil) (n ¼ 46) per day from 20 weeks gestation until delivery. Main outcome measures: Erythrocyte phospholipid fatty acids were measured in maternal peripheral blood at 20, 30 and 37 weeks of pregnancy and at 6 weeks post partum, and from cord blood collected at birth. Results: Compared to the control group, maternal EPA and DHA were significantly higher in the fish oil group at 30 and 37 weeks gestation, and remained elevated at 6 weeks post partum (Po0.001). The proportions of n-6 polyunsaturated (arachidonic acid, 22:3n-6 and 22:4n-6) were significantly lower in the fish oil supplemented group at the same time periods (Po0.001). Similarly, the proportions of EPA and DHA were significantly higher (Po0.001), and those of n-6 polyunsaturated fatty acids arachidonic acid, 20:3n-6, 22:3n-6 and 22:4n-6 were significantly lower (Po0.001), in erythrocytes from neonates in the fish oil group, compared to those in the control group. Conclusion: Fish oil supplementation from 20 weeks of pregnancy until birth is an effective means of enhancing n-3 fatty acid status of both mothers and neonates. Furthermore, the changes in maternal erythrocyte fatty acid composition are retained until at least 6 weeks post partum. It is essential to assess the effects of concomitant decreases in arachidonic acid status before any dietary recommendations can be made.

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Section: Discussioncontrasting

confidence: 65%

Effects of n-3 polyunsaturated fatty acid supplementation in pregnancy on maternal and fetal erythrocyte fatty acid composition

et al. 2004

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“…These metabolic substrates can be utilized by most maternal tissues, sparing glucose for glucose-obligatory tissues. In our experiments, as expected, because of the high lipolytic activity [1][2][3], in 20-day pregnant rats, plasma levels of FFA, glycerol, and TG were higher than in virgin animals. The administration of acipimox to 20-day pregnant rats decreased the plasma levels of FFA, glycerol, and TG by >50%.…”

Section: Discussionsupporting

confidence: 88%

“…Both in humans and rats, at the end of pregnancy, there are increased levels of plasma TG and FFA [1][2][3]. These metabolic substrates can be utilized by most maternal tissues, sparing glucose for glucose-obligatory tissues.…”

Section: Discussionmentioning

confidence: 99%

“…Over a short period of time, in pregnant rats, reductions of plasma FFA and TG after acipimox treatment improved the glucose-induced insulin release, but did not seem to have any effect in peripheral insulin resistance. The enhanced lipolytic activity present during late gestation gives rise to an elevation in plasma free fatty acids (FFA) and triglycerides (TG), both in women and rats [1][2][3]. Some tissues use fatty acids as fuel, sparing glucose for the fast-growing fetus and those maternal tissues that can only use glucose as fuel energy [4].…”

mentioning

confidence: 99%

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Effect of Acipimox on Plasma Lipids and Glucose/Insulin in Pregnant Rats

Sánchez-Vera

Bonet

Viana

et al. 2002

Journal of Diabetes Research

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To determine how a reduction in maternal hypertriglyceridemia during late pregnancy may affect glucose/insulin relationships, pregnant and virgin rats were orally treated with acipimox, a potent antilipolytic agent. In 20-day pregnant rats receiving 80 mg of acipimox, plasma triglycerides (TG), free fatty acids (FFA), and glycerol decreased more than in virgin rats shortly after the drug (up to 7 hours), when compared with animals treated with distilled water, whereas plasma glucose level was unaffected by the treatment in either group of rats. When acipimox was given every 12 hours from day 17 to day 20 of pregnancy, plasma TG, FFA, and glycerol levels progressively increased, whereas they either decreased or did not change in virgin rats receiving the same treatment, with no effect in plasma glucose levels in either group. Fetal body weight was lower than in controls in 20-day pregnant rats that received acipimox for 3 days. On day 20 of pregnancy, 3 hours after receiving acipimox or distilled water, rats received a 2 g glucose/kg oral load and it was found that the change in plasma glucose was similar in both groups, whereas the increase in plasma insulin was greater in pregnant rats treated with acipimox. However, no difference was found in either variable after the oral glucose load in virgin rats receiving acipimox or distilled water. No differences in plasma glucose levels were found after intravenous (IV) administration of insulin in pregnant rats treated or not treated with acipimox. In conclusion, present results show that administration of acipimox during the last days of gestation inhibited lipolysis and decreased fetal weight. Over a short period of time, in pregnant rats, reductions of plasma FFA and TG after acipimox treatment improved the glucose-induced insulin release, but did not seem to have any effect in peripheral insulin resistance. The enhanced lipolytic activity present during late gestation gives rise to an elevation in plasma free fatty acids (FFA) and triglycerides (TG), both in women and rats [1][2][3]. Some tissues use fatty acids as fuel, sparing glucose for the fast-growing fetus and those maternal tissues that can only use glucose as fuel energy [4]. The mechanisms involved in this elevated lipolytic activity are uncertain, but the rising levels of placental lactogen and the insulin resistance during late pregnancy seem to play a relevant role [5][6][7].The enhanced availability of FFA to the liver seems to contribute to the increased production of TG by this organ [8] and therefore to the development of maternal hypertriglyceridemia. Exaggerated increment of TG in maternal circulation may be involved in some of the pregnancy-induced complications, including eclampsia [9] and insulin resistance that would cause the development of gestational diabetes [7], 2 of the most common pregnancy-induced complications. Therefore, decreasing the hypertriglyceridemia of late pregnancy may be of therapeutic use. Nevertheless, this therapeutic approach may not be risk free for the fetus, becaus...

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“…Enhanced insulin sensitivity in the last half of the first trimester might be due to a decline in levels of anti-insulin hormones (1,7,8,24). Specifically, a fall in insulin requirements in the first trimester may be mediated through a decline in progesterone, an anti-insulin hormone (7,24).…”

Section: Falling Insulin Requirement In Pregnancymentioning

confidence: 99%

Declining Insulin Requirement in the Late First Trimester of Diabetic Pregnancy

et al. 2001

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OBJECTIVE -To investigate whether pregnancies complicated by type 1 diabetes are associated with a decrease in first-trimester insulin requirement.RESEARCH DESIGN AND METHODS -We examined the weekly insulin requirement (as units per kilogram per day) during the first trimester of pregnancy in diabetic women in the Diabetes in Early Pregnancy Study (DIEP) with accurate gestational dating, regular glucose monitoring, daily insulin-dose recording, and monthly glycohemoglobin measurements.RESULTS -In pregnancies that resulted in live-born full-term singleton infants, a significant 18% increase in mean weekly dosage was observed between weeks 3 and 7 (P ϭ 0.000), followed by a significant 9% decline from week 7 through week 15 (P ϭ 0.000). Further testing localized a significant change in insulin dose in the interval beginning weeks 7-8 and ending weeks 11-12 (P ϭ 0.014). Within this interval, the maximum decrease was between weeks 9 and 10 (mean), 10 and 11 (median), and 8 and 9 (most frequent maximal decrease). To determine whether prior poor glucose control exaggerated these trends, we categorized the women based on their glycohemoglobin values: Ͻ2 SDs above the mean of a normal population (subgroup 1), 2-4 SDs (subgroup 2), and Ͼ4 SDs (subgroup 3) at baseline. Late first-trimester declines in dosage were statistically significant in subgroup 2 (P ϭ 0.002) and subgroups 2 and 3 together (P ϭ 0.003). Similarly, women with BMI Ͼ27.0 had a greater initial insulin rise and then fall compared with leaner women. CONCLUSIONS -Observations in the DIEP cohort disclose a mid-first-trimester decline in insulin requirement in type 1 diabetic pregnant women. Possible explanations include overinsulinization of previously poorly controlled diabetes, a transient decline in progesterone secretion during the late first-trimester luteo-placental shift in progesterone secretion, or other hormonal shifts. Clinicians should anticipate a clinically meaningful reduction in insulin requirement in the 5-week interval between weeks 7 and 12 of gestation.

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Lipid Metabolism in Pregnancy

Cited by 31 publications

References 223 publications

Effects of n-3 polyunsaturated fatty acid supplementation in pregnancy on maternal and fetal erythrocyte fatty acid composition

Effects of n-3 polyunsaturated fatty acid supplementation in pregnancy on maternal and fetal erythrocyte fatty acid composition

Effect of Acipimox on Plasma Lipids and Glucose/Insulin in Pregnant Rats

Declining Insulin Requirement in the Late First Trimester of Diabetic Pregnancy

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