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University Departments of Obstetrics and Gynaecology (J.E.R., I.A.G.), Medicine (W.R.F.), and Pathological Biochemistry (L.C., N.S.), Glasgow Royal Infirmary, Scotland, G31 2ER, United Kingdom
Address all correspondence and requests for reprints to: Dr. Jane Ramsay, University Department of Obstetrics and Gynaecology, 3rd Floor, Queen Elizabeth Building, Glasgow Royal Infirmary, 10 Alexandra Parade, Glasgow, G31 2ER, United Kingdom. E-mail: . jer6q{at}clinmed.gla.ac.uk
Abstract
Obesity is increasing in prevalence worldwide and in all age groups. In nonpregnant individuals, obesity is associated with dyslipidemia; hyperinsulinemia; vascular dysfunction; and, more recently, low-grade chronic inflammation. However, whether such effects are sustained during pregnancy has been sparsely investigated but is important to establish, given the association of maternal obesity with numerous adverse metabolic and vascular consequences.
We consecutively recruited 47 healthy women in the third trimester of pregnancy and divided the participants into 2 groups, lean [n = 24; median body mass index (BMI), 22.1 kg/m2] and obese (n = 23; median BMI, 31.0 kg/m2) around the median first trimester BMI. The age, parity, and smoking history were comparable in both groups. A detailed panel of metabolic and inflammatory parameters was measured and an in vivo assessment of endothelial-dependent and -independent microvascular function made using laser doppler imaging. Although low-density lipoprotein cholesterol and glycosylated hemoglobin were similar, fasting triglyceride concentrations were higher [2.70 (interquartile range, 2.3–3.21) vs. 2.20 (IQ range, 2.0–2.6) mmol/liter, P = 0.02] and high-density lipoprotein concentrations were lower [1.55 (IQ range, 1.1–1.7) vs. 1.72 (IQ range, 1.4–2.0) mmol/liter, P = 0.02] in the obese group. Leptin [55.6 (range, 45–64.4) ng/ml vs. 23.8 (range, 13.2–35.2) ng/ml, P < 0.0001] and fasting insulin [14.5 (range, 11.4–27.3) vs. 6.5 (range, 4.6–9.7) mU/liter, P < 0.0001] levels were more than double. Similarly, levels of inflammatory parameters, IL-6 [3.15 (range, 2.4–3.5) vs. 2.1 (range, 1.73–2.85) pg/ml, P = 0.003], and sensitive C-reactive protein [4.45 (range, 2.9–6.6) vs. 2.25 (range, 0.92–3.65) mg/ml, P = 0.0015] were also substantially elevated. Both endothelial-dependent and -independent vasodilatory responses were significantly reduced in the obese group (P = 0.0003 and P = 0.02, respectively, ANOVA) and systolic blood pressure was higher (P = 0.01). Metabolic factors, C-reactive protein (r = 0.289, P = 0.049), and insulin (r = 0.339, P = 0.02) were related inversely to endothelial-dependent function.
These comprehensive data demonstrate that, as in nonpregnant obese individuals, obesity in pregnancy is associated not only with marked hyperinsulinemia (without necessarily glucose dysregulation) and dyslipidemia but also impaired endothelial function, higher blood pressure, and inflammatory up-regulation. Such a spectrum of risk factors may contribute to maternal complications in obese women and, as a result, influence fetal programming of adult vascular disease. Clearly, these data provide further rationale to examine the potential benefits of preconceptual weight loss and antenatal exercise.
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