The impact of preconceptional obesity on trajectories of maternal lipids during gestation

Abstract

Growing challenges of maternal obesity necessitate to focus metabolic management on alternative factors than glycaemia. The objective is to assess longitudinal changes in lipids and inflammatory parameters during pregnancies stratified by pregestational BMI. Therefore, 222 pregnant women (normal-weight BMI < 25: n = 91 (41%), overweight BMI 25–29.9: n = 69 (31%), obese BMI ≥ 30: n = 62 (28%)) underwent a detailed metabolic characterization including fasting lipids and glucometabolic parameters at <21st gestational week (GW) with follow-up assessments at further three visits (24–28th GW, 32–34th GW, >36th GW). Overweight and obesity was related to dyslipidemia already at baseline, i.e. elevated triglycerides (TG, p < 0.001), decreased high-density-lipoprotein-C (p = 0.009) and increased ultrasensitive-c-reactive-protein (usCRP, p < 0.001) independent of gestational diabetes prevalence. Trajectories of lipids during pregnancy progress revealed an unexpected less pronounced increase in TG, low-density-lipoprotein-C and total-cholesterol in overweight/obese women. usCRP remained associated with higher BMI throughout pregnancy showing no time-dependent longitudinal changes. Newborns of obese/overweight women were affected by higher birth-weight percentiles. Regarding lipids only maternal TG showed tendency for relation to prevalence of large-for-gestational-age offspring, particularly at the end of pregnancy (p = 0.048). Overweight and obese women show significant differences in trajectories of lipids during pregnancy that distinguish them from normal-weight women. Further studies should evaluate if targeting lipid metabolism could improve clinical management of maternal obesity.

Adiponectin and Leptin at Early Pregnancy: Association to Actual Glucose Disposal and Risk for GDM—A Prospective Cohort Study

“…This longitudinal study was conducted prospectively at the Department of Internal Medicine III, Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, between 2010 and 2014 as previously reported in [ 12 , 13 ]. Study participants were recruited among pregnant women attending our diabetes and pregnancy outpatient clinics at a tertiary care center ≤ 21st week of gestation (GW, visit 1) for the assessment of glucose tolerance and were reevaluated during further clinical follow-up periods: 24th–28th GW (visit 2), 30th–34th GW (visit 3), and >36th GW (visit 4) as well as 8–12 months after pregnancy (visit 5).…”

“…At each visit, an additional venous blood sample was drawn in fasting condition for further laboratory analysis. Herein, total adiponectin and leptin were measured in duplicates using radioimmunoassay (RIA) purchased from Millipore, Billerica, MA [ 12 , 13 ].…”

Metabolic profiling of gestational diabetes in obese women during pregnancy

“…In contrast, obese women demonstrate reduced insulin sensitivity from an earlier gestation, particularly with regard to lipid metabolism [1]. Using non-NMR methods, others have reported dyslipidaemia in obese vs normal-weight pregnancy, including raised total and LDL-cholesterol, lower HDLcholesterol and raised triacylglycerols from the first trimester [24][25][26][27]. The exaggerated dyslipidaemia in obese women prior to and at the time of diagnosis of GDM in the present study suggests exaggeration of these metabolic processes, reflecting enhanced insulin resistance in adipose tissue and reduced suppression of lipolysis [28].…”

Plasma concentrations of lipids during pregnancy and the risk of gestational diabetes mellitus: A longitudinal study

“…Changes in lipids and lipoproteins could be the result of increased maternal hormone concentrations and other maternal factors, such as prepregnancy BMI and gestational weight gain. [24][25][26][27] Diareme et al 28 reported that the rate of changes in individual plasma lipids varied during normal pregnancy, with triglycerides showing the largest increase and HDL-C the smallest. Similar to previous reports, 24 we observed an initial slow slope in the increase of triglyceride concentrations in the first trimester, followed by a large increase towards the second trimester and doubled concentrations in the third trimester, although not all triglyceride concentrations in the present study were measured in fasting samples.…”