Longitudinal changes in body composition and energy balance in lean women with normal and abnormal glucose tolerance during pregnancy - 09/09/11
Abstract |
OBJECTIVE: The objective of this study was to evaluate the longitudinal changes in energy expenditure and body composition in relationship to alterations in carbohydrate metabolism in women with normal and abnormal glucose metabolism. We hypothesized that women with decreased insulin sensitivity before conception would have less fat accretion and smaller increases in energy expenditure.
STUDY DESIGN: Six women with normal glucose tolerance and 10 women with abnormal glucose tolerance were evaluated before conception, and in early (12 to 14 weeks) and late (34 to 36 weeks) gestation. Body composition was estimated by hydrodensitometry, resting energy expenditure, and glucose and fat metabolism by indirect calorimetry, endogenous glucose production by infusion of [6-6 2H..2] glucose, and insulin sensitivity using a hyperinsulinemic-euglycemic clamp (40 mU/m2/min).
RESULTS: There was a smaller increase in fat mass (1.3 kg [P = .04]) in early pregnancy in women with abnormal glucose tolerance before pregnancy. Indirect calorimetry measured gestational age–related increases in basal oxygen utilization, with or without correction for fat-free mass (v̇o2, P = .002), resting energy expenditure (expressed in kilocalories, P = .0001), and carbohydrate oxidation (P = .0003). The insulin-mediated elevation in v̇o2 increased in later gestation v̇o2 (P = .005), as did resting energy expenditure (P = .0001) and fat oxidation (P = 0.0001). However, there was a decrease in respiratory quotient (P = .0001), carbohydrate oxidation (P = .002), and nonoxidative carbohydrate metabolism (P = .0001) with advancing gestation during insulin infusion. In early pregnancy, changes in fat mass correlated inversely with changes in insulin sensitivity (r = –0.52, P = .04) and changes in basal v̇o2 correlated inversely with decreases in basal endogenous glucose production (r = –0.74, P = .01).
CONCLUSION: In early gestation, the changes in maternal fat mass and basal oxygen consumption are inversely related to the changes in insulin sensitivity. This response in lean women with decreased insulin sensitivity before conception may have survival value by providing a larger amount of available substrate to meet fetoplacental needs during gestation. (Am J Obstet Gynecol 1998;179:156-65.)
Le texte complet de cet article est disponible en PDF.Keywords : Pregnancy, insulin resistance, energy expenditure, body composition
Plan
 | From the Department of Reproductive Biology, Case Western Reserve University at MetroHealth Medical Center,a and the Endocrine Metabolic Unit, Department of Medicine, University of Vermont College of Medicine.b |
| Supported by National Institutes of Health grant No. 22965 and the General Clinical Research Center at the Medical Center Hospital of Vermont, grant No. RR-109 and No. RR-080. |
 | Reprint requests: Patrick M. Catalano, MD, Department of Reproductive Biology, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Dr, Cleveland, OH 44109. |
| 0002-9378/98 $5.00 +0 6/1/87729 |
Vol 179 - N° 1
P. 156-165 - juillet 1998 Retour au numéro
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