Energy balances of healthy Dutch women before and during pregnancy: limited scope for metabolic adaptations in pregnancy

Groot, Lisette C. P. G. M. de; Boekholt, H.A.; Spaaij, C. J. K.; Raaij, J.M.A. van; Drijvers, J. J. M. M.; Heijden, L.J.M. van der; Heide, D. van der; Hautvast, J.G.A.J.

doi:10.1093/ajcn/59.4.827

Cited by 21 publications

(12 citation statements)

References 18 publications

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“…Individual changes from baseline (t 0 , prepregnancy) in fat mass (FM) throughout pregnancy: t 1 , 8-10 wk gestation; t 2 , 24-26 wk gestation; t 3 , 34-36 wk gestation; t post , 4-6 wk postpartum. more energy from their food during pregnancy was refuted by de Groot et al (50). Indian women reportedly increase their intake enough to cover 96% of their estimated cost of pregnancy (15).…”

Section: Discussionmentioning

confidence: 99%

Longitudinal assessment of energy balance in well-nourished, pregnant women

Kopp-Hoolihan

Loan

Wong

et al. 1999

The American Journal of Clinical Nutrition

116

109

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Background: Clinicians often recommend an additional energy intake of 1250 kJ/d to their pregnant patients. Previous studies have shown considerable variation in the metabolic response to pregnancy and thus in the additional energy required to support a pregnancy. Objective: The purpose of this study was to assess how wellnourished women meet the energy demands of pregnancy and to identify factors that predict an individual's metabolic response. Design: Resting metabolic rate (RMR), diet-induced thermogenesis (DIT), total energy expenditure (TEE), activity energy expenditure (AEE), energy intake (EI), and body fat mass (FM) were measured longitudinally in 10 women preconception; at 8-10, 24-26, and 34-36 wk of gestation; and 4-6 wk postpartum. Results: Compared with preconception values, individual RMRs increased from 456 to 3389 kJ/d by late pregnancy. DIT varied from Ϫ266 to 110 kJ/meal, TEE from Ϫ105 to 3421 kJ/d, AEE from Ϫ2301 to 2929 kJ/d, EI from Ϫ259 to 2176 kJ/d, and FM from a 0.6-kg loss to a 10.6-kg gain. The only prepregnant factor that predicted FM gain was RMR (r = 0.65, P < 0.05). Women with the largest cumulative increase in RMR deposited the least FM (r = Ϫ0.64, P < 0.05). Conclusions: Well-nourished women use different strategies to meet the energy demands of pregnancy, including reductions in DIT or AEE, increases in EI, and deposition of less FM than anticipated. The combination of strategies used by individual women is not wholly predictable from prepregnant indexes. The use of a single recommendation for increased energy intake in all pregnant women is not justified. 1999;69:697-704. Am J Clin Nutr

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Section: Discussionmentioning

confidence: 99%

Longitudinal assessment of energy balance in well-nourished, pregnant women

Kopp-Hoolihan

Loan

Wong

et al. 1999

The American Journal of Clinical Nutrition

116

109

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“…Energy-sparing and energy-profligate responses to pregnancy were dependent on prepregnancy body fatness. In 12 Dutch women, the late-pregnancy increment in absolute TEE varied from 9.5% to 26% (28).…”

Section: Energy Expenditure During Pregnancymentioning

confidence: 99%

Adjustments in energy expenditure and substrate utilization during late pregnancy and lactation

Butte

Hopkinson

Mehta

et al. 1999

The American Journal of Clinical Nutrition

210

166

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Background: Metabolic adjustments occur during pregnancy and lactation to support fetal growth and milk synthesis; however, the effect of body composition and hormonal milieu on these changes is poorly understood. Objective: We hypothesized that energy metabolism changes during pregnancy and lactation to support fetal growth and milk synthesis, and that body composition and hormonal milieu influence these alterations. Design: We measured energy expenditure, body composition, and hormone, metabolite, and catecholamine concentrations in 76 women (40 lactating, 36 nonlactating) at 37 wk gestation and 3 and 6 mo postpartum. Total energy expenditure (TEE), basal metabolic rate (BMR), sleeping metabolic rate (SMR), and minimal SMR (MSMR) were measured with room calorimetry. Fatfree mass (FFM) and fat mass were estimated with a 4-component model. Results: TEE, BMR, SMR, and MSMR were 15-26% higher during pregnancy than postpartum after being adjusted for FFM, fat mass, and energy balance. TEE, SMR, and MSMR were higher in lactating than in nonlactating women. Fasting serum insulin, insulin-like growth factor I, fatty acids, and leptin, and 24-h urinary free norepinephrine, epinephrine, and dopamine correlated positively with TEE, BMR, SMR, and MSMR. In nonlactating women, the respiratory quotient decreased over time, carbohydrate oxidation decreased, and fat oxidation increased. Substrate utilization was not influenced by body composition, fasting serum hormones, or 24-h urinary catecholamines. Conclusions: These results indicate increased energy expenditure and preferential use of carbohydrates during pregnancy and lactation. Elevated respiratory quotient and carbohydrate utilization during pregnancy continue during lactation, consistent with preferential use of glucose by the fetus and mammary gland. Am J Clin Nutr 1999;69:299-307.

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“…Total energy expenditure by respiratory calorimetry or doubly labelled water method Whole room respiration calorimetry has been performed in well-nourished women 31,34,38,39 and marginally-nourished women 40 during pregnancy ( Table 5). These shortterm 24-hour studies can demonstrate changes in energy expenditure under standardised protocols, but make no allowance for free-living physical activity.…”

Section: Basal Metabolismmentioning

confidence: 99%

Energy requirements during pregnancy and lactation

Butte

King²

2005

Public Health Nutr.

379

319

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Objective: To estimate the energy requirements of pregnant and lactating women consistent with optimal pregnancy outcome and adequate milk production. Design: Total energy cost of pregnancy was estimated using the factorial approach from pregnancy-induced increments in basal metabolic rate measured by respiratory calorimetry or from increments in total energy expenditure measured by the doubly labelled water method, plus energy deposition attributed to protein and fat accretion during pregnancy. Setting: Database on changes in basal metabolic rate and total energy expenditure during pregnancy, and increments in protein based on measurements of total body potassium, and fat derived from multi-compartment body composition models was compiled. Energy requirements during lactation were derived from rates of milk production, energy density of human milk, and energy mobilisation from tissues. Subjects: Healthy pregnant and lactating women. Results: The estimated total cost of pregnancy for women with a mean gestational weight gain of 12.0 kg, was 321 or 325 MJ, distributed as 375, 1200, 1950 kJ day 21 , for the first, second and third trimesters, respectively. For exclusive breastfeeding, the energy cost of lactation was 2.62 MJ day 21 based on a mean milk production of 749 g day 21, energy density of milk of 2.8 kJ g 21, and energetic efficiency of 0.80. In well-nourished women, this may be subsidised by energy mobilisation from tissues on the order of 0.72 MJ day 21, resulting in a net increment of 1.9 MJ day 21 over nonpregnant, non-lactating energy requirements. Conclusions: Recommendations for energy intake of pregnant and lactating women should be updated based on recently available data.

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Energy balances of healthy Dutch women before and during pregnancy: limited scope for metabolic adaptations in pregnancy

Cited by 21 publications

References 18 publications

Longitudinal assessment of energy balance in well-nourished, pregnant women

Longitudinal assessment of energy balance in well-nourished, pregnant women

Adjustments in energy expenditure and substrate utilization during late pregnancy and lactation

Energy requirements during pregnancy and lactation

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