Physical fitness and plasma leptin in women with recent gestational diabetes

Abstract

Aims/HypothesisLow physical fitness (PF) is a risk factor for type 2 diabetes mellitus (T2D). Women with a history of gestational diabetes (GDM) are at risk for T2D at a young age, but the role of PF in this population is not clear. PF has also been found to correlate inversely with plasma leptin in previous studies. Here, we examine whether women who had GDM have lower PF than women after a normoglycemic pregnancy and, second, whether PF is associated with plasma leptin, independently of body fat mass.MethodsCross-sectional analysis of 236 participants in the PPSDiab Study (cohort study of women 3–16 months after delivery, 152 after gestational diabetes (pGDM), 84 after normoglycemic pregnancy (control subjects); consecutively recruited 2011–16); medical history, physical examination with bioelectrical impedance analysis (BIA), whole body magnetic resonance imaging (MRI) (n = 154), 5-point oral glucose tolerance test, cardiopulmonary exercise testing, clinical chemistry including fasting plasma leptin; statistical analysis with Mann–Whitney U and t -test, Spearman correlation coefficient, multiple linear regression.ResultsWomen pGDM had lower maximally achieved oxygen uptake (VO2peak/kg: 25.7(21.3–29.9) vs. 30.0(26.6–34.1)ml/min/kg; total VO2peak: 1733(1552–2005) vs. 1970(1767–2238)ml/min; p<0.0001 for both), and maximum workload (122.5(105.5–136.5) vs. 141.0(128.5–159.5)W; p<0.0001). Fasting plasma leptin correlated inversely with PF (VO2peak/kg ρ = -0.72 p<0.0001; VO2peak ρ = -0.16 p = 0.015; max. load ρ = -0.35 p<0.0001). These associations remained significant with adjustment for body mass index, or for body fat mass (BIA and MRI).Conclusions/InterpretationWomen with a recent history of GDM were less fit than control subjects. Low PF may therefore contribute to the risk for T2D after GDM. This should be tested in intervention studies. Low PF also associated with increased leptin levels–independently of body fat. PF may therefore influence leptin levels and signaling. This hypothesis requires further investigation.

International Fitness Scale—IFIS: Validity and association with health‐related quality of life in pregnant women

“…During pregnancy, the relevance of physical fitness has also been highlighted. Low physical fitness levels are associated with low infant birth weight, higher risk of gestational diabetes mellitus (GDM), worse postpartum recovery, and worse delivery outcomes…”

“…[4][5][6] During pregnancy, the relevance of physical fitness has also been highlighted. Low physical fitness levels are associated with low infant birth weight, 7 higher risk of gestational diabetes mellitus (GDM), 8,9 worse postpartum recovery, 10 and worse delivery outcomes. 11 Physical fitness can be divided into several health-related components: cardiorespiratory fitness (CRF), the ability to perform large muscle, dynamic, moderate-to-vigorous intensity exercise for prolonged periods of time 12 ; muscle strength, the muscle's ability to exert a maximal force on one occasion 12 ; and flexibility, the ability to move a joint through its complete range of motion 12 ; others.…”

Physical Fitness and Its Relationship to Plasma Leptin, Leptin Soluble Receptor, and Free Leptin Index in a Saudi Population: A Comparison Between Diabetic and Non-Diabetic Individuals

“…A group of investigators reported lower fitness level among patients with gestational diabetes when compared with pregnant women having normal blood glucose levels. The same study found that after adjustment for BMI and body fat mass, there was a significant negative correlation between physical fitness and serum leptin level in the whole study cohort [ 15 ]. Regular exercise, which is known to increase plasma epinephrine, is necessary to achieve and maintain physical fitness.…”

Effect of Gestational Diabetes on Serum Leptin during Pregnancy and Postpartum Period

“…Hence, the maternal serum leptin levels attain peak level till the 28 th week of gestation then gradually decreases and after the delivery becomes normal due to expulsion of placenta (5). Leptin increases the body's insulin sensitivity through the regulation of insulin-mediated glucose metabolism by skeletal muscles and by hepatic regulation of gluconeogenesis (6,7). Pregnancy is associated with leptin resistance as leptin mRNA receptor is found to decrease during pregnancy.…”