Metabolic flexibility is impaired in women who are pregnant and overweight/obese and related to insulin resistance and inflammation

Tinius, Rachel A.; Blankenship, Maire M.; Furgal, Karen; Cade, W. Todd; Pearson, Kevin J.; Rowland, Naomi S.; Pearson, Regis C.; Hoover, Donald L.; Maples, Jill M.

doi:10.1016/j.metabol.2020.154142

Cited by 45 publications

(35 citation statements)

References 70 publications

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“…Current understanding of the consequences of metabolic dysfunction during pregnancy has largely been established among mothers with obesity in pregnancy or GD. Pre‐existing maternal metabolic dysfunction exacerbates the physiological insulin resistance of pregnancy, resulting in further metabolic derangements 4, 6 such as impaired glucose metabolism, worsening insulin resistance, impaired fat oxidation, and inflammation 19 . This metabolic dysfunction could impact maternal and neonatal health in many ways 7 .…”

Section: Discussionmentioning

confidence: 99%

Hyperinsulinemia during pregnancy across varying degrees of glucose tolerance: An examination of the Kraft database

North

Zinn

Crofts

2021

J of Obstet and Gynaecol

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Aim Hyperinsulinemia is a known underlying driver of metabolic disease; however, its role in pregnancy complications is less understood due to insulin measurement not being a part of standard clinical assessments. This study aimed to characterize hyperinsulinemia in pregnancy by gestational diabetes (GD) status using Kraft methodology. Methods We analyzed historical data from 926 pregnant women who underwent a 100‐g oral glucose tolerance test (OGTT), which included insulin measurement. Subjects were grouped by GD diagnosis status (“Normal”, “Borderline”, “GD”) and insulin responses over 3 h were compared between groups. Results “GD” was diagnosed in 20.3% of the subjects and 13.8% were grouped as “Borderline.” The prevalence of hyperinsulinemia using the Kraft algorithm was 33.1% for Kraft IIB and 42.0% for Kraft III. Compared to normal glucose‐tolerant mothers, individuals from the “Borderline” group had an exacerbated insulin response, although not to the same magnitude as those with “GD.” Conclusions Dynamic OGTT insulin measurement during pregnancy may provide a meaningful assessment of metabolic risk among women who would otherwise not be diagnosed with GD.

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Section: Discussionmentioning

confidence: 99%

Hyperinsulinemia during pregnancy across varying degrees of glucose tolerance: An examination of the Kraft database

North

Zinn

Crofts

2021

J of Obstet and Gynaecol

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“…Healthy pregnant women were recruited between 32 and 34 weeks of gestation as part of a previously published pregnancy study. 13 After completing the pregnancy visit between 32 and 38 weeks gestation, all women were re-contacted to participate in the postpartum follow-up study between 4 and 6 months. All participants were considered eligible unless they had developed any new medical conditions that could impact metabolic health.…”

Section: Methodsmentioning

confidence: 99%

Postpartum Metabolism: How Does It Change from Pregnancy and What are the Potential Implications?

Tinius¹,

Yoho²,

Blankenship³

et al. 2021

IJWH

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Background Metabolic dysfunction after pregnancy may have serious consequences for a new mother. The purpose of the study was to characterize basic changes that occur in metabolic profiles from late pregnancy through 4–6 months postpartum. A secondary purpose was to determine metabolic factors that may be contributing to postpartum weight retention. Methods Participants (n=25) came in for 2 visits: late pregnancy (~34 weeks gestation) and postpartum (4-6 months). Resting metabolic rate (RMR), respiratory quotient (RQ), and substrate oxidation values were assessed for 15 minutes during fasted conditions. Blood was drawn and skinfold anthropometry was performed to assess additional outcomes (inflammation, insulin resistance, lipid profiles, body composition). The participants completed a number of surveys that examined other lifestyle and demographic data of interest. At the postpartum visit, additional assessments regarding sleep and breastfeeding habits were administered. Results RMR was lower during postpartum (1517.2±225.1 kcal/day) compared to pregnancy (1867.9±302.6 kcal/day) (p<0.001), and remained lower when expressing RMR per kg body weight (postpartum: 22.3±2.7 vs pregnant: 23.7±3.4 kcal/kg, (p=0.034). Relative RMR (RMR per kg body weight) was negatively correlated to insulin resistance (HOMA-IR) during postpartum (r=−.463, p=0.034). Maternal HOMA-IR, inflammation (CRP), triglycerides (TAG), and carbohydrate oxidation were all positively correlated to postpartum weight retention (HOMA-IR: r=0.617, p=0.004; CRP: r=0.477, p=0.039, TAG: r=0.463, p=0.040; Carbohydrate Oxidation: (r=0.469, p=0.018). Conclusion Metabolic rate is lower during postpartum compared to pregnancy, and may be connected to insulin resistance. Maternal insulin resistance, inflammation, blood lipids, and substrate metabolism are all related to postpartum weight retention.

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“…Participants were a subset from a larger previously published cohort [ 17 ]. In the parent study, participants were enrolled to determine the impact that overweight/obesity has on substrate metabolism in response to a high-fat meal challenge in late pregnancy.…”

Section: Methodsmentioning

confidence: 99%

“…The maternal metabolic study visit has been described previously [ 17 ]. Briefly, participants reported to the lab for the metabolic study visit in the morning after an overnight fast.…”

Section: Methodsmentioning

confidence: 99%

Elevated lipid oxidation is associated with exceeding gestational weight gain recommendations and increased neonatal anthropometrics: a cross-sectional analysis

Maples

Ehrlich

Zite

et al. 2021

BMC Pregnancy Childbirth

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Background Deviations from gestational weight gain (GWG) recommendations are associated with unfavorable maternal and neonatal outcomes. There is a need to understand how maternal substrate metabolism, independent of weight status, may contribute to GWG and neonatal outcomes. The purpose of this study was to explore the potential link between maternal lipid oxidation rate, GWG, and neonatal anthropometric outcomes. Methods Women (N = 32) with a lean pre-pregnancy BMI were recruited during late pregnancy and substrate metabolism was assessed using indirect calorimetry, before and after consumption of a high-fat meal. GWG was categorized as follows: inadequate, adequate, or excess. Shortly after delivery (within 48 h), neonatal anthropometrics were obtained. Results Using ANOVA, we found that fasting maternal lipid oxidation rate (grams/minute) was higher (p = 0.003) among women with excess GWG (0.1019 ± 0.0416) compared to women without excess GWG (inadequate = 0.0586 ± 0.0273, adequate = 0.0569 ± 0.0238). Findings were similar when lipid oxidation was assessed post-meal and also when expressed relative to kilograms of fat free mass. Absolute GWG was positively correlated to absolute lipid oxidation expressed in grams/minute at baseline (r = 0.507, p = 0.003), 2 h post-meal (r = 0.531, p = 0.002), and 4 h post-meal (r = 0.546, p = 0.001). Fasting and post-meal lipid oxidation (grams/minute) were positively correlated to neonatal birthweight (fasting r = 0.426, p = 0.015; 2-hour r = 0.393, p = 0.026; 4-hour r = 0.540, p = 0.001) and also to neonatal absolute fat mass (fasting r = 0.493, p = 0.004; 2-hour r = 0.450, p = 0.010; 4-hour r = 0.552, p = 0.001). Conclusions A better understanding of the metabolic profile of women during pregnancy may be critical in truly understanding a woman’s risk of GWG outside the recommendations. GWG counseling during prenatal care may need to be tailored to women based not just on their weight status, but other metabolic characteristics.

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Metabolic flexibility is impaired in women who are pregnant and overweight/obese and related to insulin resistance and inflammation

Cited by 45 publications

References 70 publications

Hyperinsulinemia during pregnancy across varying degrees of glucose tolerance: An examination of the Kraft database

Hyperinsulinemia during pregnancy across varying degrees of glucose tolerance: An examination of the Kraft database

Postpartum Metabolism: How Does It Change from Pregnancy and What are the Potential Implications?

Elevated lipid oxidation is associated with exceeding gestational weight gain recommendations and increased neonatal anthropometrics: a cross-sectional analysis

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