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

Abstract

AimsDisrupted intermediary metabolism may contribute to the adverse pregnancy outcomes in women with very severe obesity. Our aim was to study metabolism in such pregnancies.MethodsWe 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).ResultsAlthough 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/interpretationPregnancies 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.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-015-3708-3) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

When and How Should Chinese Pregnant Women Exercise? A Longitudinal Study in China

“…The discrepant findings may be related to differences in participants with normal weight and overweight/obesity or in the instrument of PA assessment. Some studies showed that the pregnancy processes differ between normal weight and overweight/obese women [24,25]. For example, most participants (69.6%) had normal weight before pregnancy in our study, in contrast to only 36% in Ehrlich et al's study [12].…”

Higher Numbers of Pregnancies Associated With an Increased Prevalence of Gestational Diabetes Mellitus: Results From the Healthy Baby Cohort Study

“…It's reported that obese women demonstrate less weight gain and smaller rises in fasting plasma glucose during pregnancy. 33 Thus, pregnancies appear to have less effect on glucose homeostasis in obese women. Therefore, although the obesity=overweight women had higher GDM prevalence, the association between the number of pregnancies and GDM was not significant.…”

Obesity, fertility and pregnancy: can we intervene to improve outcomes?

“…Obese women are more insulin resistant than lean women, even as early as at antenatal booking, and they are more insulin resistant and have higher glucose levels throughout pregnancy (Forbes et al 2015). Data from the HAPO (Hyperglycaemia and Adverse Pregnancy Outcomes) study, including 37,000 women who had a glucose tolerance test during pregnancy showed that a higher glucose as measured by a higher fasting glucose, 1-h glucose post the glucose challenge or 2 h post the glucose challenge was associated with an increased risk of birthweight greater than the 90th percentile (Metzger et al 2008).…”