Maternal Adiposity and Energy Balance After Normotensive and Preeclamptic Pregnancies

Abstract

Background Preeclampsia is a major pregnancy complication associated with long-term maternal cardiometabolic disease. Research generally is focused on metabolic and pathophysiological changes during pregnancy, however, there is much less focus on the early postpartum period in subjects who suffered preeclampsia. The aim of this study was to (a) characterise energy intake and expenditure six months following normotensive and preeclamptic pregnancies, and (b) examine associations between energy balance, body composition, insulin resistance measures (HOMA-IR), and clinical characteristics. Design A cross-sectional study six months following normotensive (n=75) and preeclamptic (n=22) pregnancies was performed. Metabolic measurements included: anthropometrics measures, body composition via bioelectrical impedance analysis, 24-hour energy expenditure via SenseWear Armbands, energy intake via a three-day food diary, and serum metabolic parameters. Results Six months following preeclampsia, women had a significantly higher weight (77.3±20.9kg versus 64.5±11.4kg, p=0.01), fat mass percentage (FM%) (40.7±7.4% versus 34.9±8.1%, p=0.004), and insulin resistance (HOMA-IR 2.2±1.5 versus 1.0±0.7, p=0.003), as well as reduced HDL levels (1.5±0.4 mmol/L versus 1.8±0.4 mmol/L, p=0.01) compared to normotensive women. Women post-preeclampsia had lower activity-related energy expenditure (p=0.02) but a decreased total energy intake (p=0.02), leading to a more negative energy balance compared to their normotensive counterparts (-1,942 kJ/24-hours versus -480 kJ/24-hours; p=0.02). Conclusion Increases in insulin resistance and FM%, reduced HDL, and more sedentary lifestyles characterise the postpartum period following preeclamptic compared with normotensive pregnancies. Early post-preeclampsia interventions, such as lifestyle behaviour change, should be implemented and assessed to determine whether they reduce long-term cardiometabolic risk in women who experienced preeclampsia during pregnancy.

The Possibility of Using Bioelectrical Impedance Analysis in Pregnant and Postpartum Women

“…It was observed that women who were diagnosed with PE during pregnancy led a less active lifestyle after delivery in comparison to the women who did not develop PE [74]. However, this may be related to the higher percentage of caesarean sections in this group, which is usually associated with decreased activity after delivery [74,102]. Breastfeeding had no significant effect on total or activity-related energy expenditure in both normal blood pressure and PE groups.…”

“…Women with a history of PE consumed an average of 13% less kilojoules than women with normal blood pressure during pregnancy. However, the composition of macronutrients in the diets of women from both groups was similar [74].…”

“…The study found that six months after pre-eclampsia, the women presented significantly higher body weight, higher percentage of fat mass, much higher BMI as well as higher insulin resistance (HOMA-IR) and reduced HDL levels in comparison to the women with normal blood pressure during pregnancy. It was observed that women who were diagnosed with PE during pregnancy led a less active lifestyle after delivery in comparison to the women who did not develop PE [74]. However, this may be related to the higher percentage of caesarean sections in this group, which is usually associated with decreased activity after delivery [74,102].…”

“…BIA has been used in various clinical situations and pre-pregnancy and pregnancy conditions, including oedema [60], GDM [48,50,51,61,62], excessive gestational weight gain (EGWG) [2,3,48,51,52,55,57,[62][63][64][65], preeclampsia (PE) [57,60,[66][67][68][69][70][71][72][73][74], gestational hypertension (GH) [73,75] or hyperemesis gravidarum [76]. Hashimoto et al compared the impedance analysis in healthy women and in women undergoing haemodialysis whose management of bodily fluids during pregnancy is known to be complicated [35].…”

“…In the study of McLennan et al, attention was drawn to the early postpartum period in women who developed PE [74]. The study found that six months after pre-eclampsia, the women presented significantly higher body weight, higher percentage of fat mass, much higher BMI as well as higher insulin resistance (HOMA-IR) and reduced HDL levels in comparison to the women with normal blood pressure during pregnancy.…”