Top

Published in:

Open Access 01-12-2016 | Research article

Maternal, fetal and perinatal alterations associated with obesity, overweight and gestational diabetes: an observational cohort study (PREOBE)

Authors: Staffan K. Berglund, Luz García-Valdés, Francisco J Torres-Espinola, Mª Teresa Segura, Cristina Martínez-Zaldívar, María J. Aguilar, Ahmad Agil, Jose A. Lorente, Jesús Florido, Carmen Padilla, Signe Altmäe, Acensión Marcos, M. Carmen López-Sabater, Cristina Campoy, on behalf of the PREOBE team

Published in: BMC Public Health | Issue 1/2016

Abstract

Background

Maternal overweight, obesity, and gestational diabetes (GD) have been negatively associated with offspring development. Further knowledge regarding metabolic and nutritional alterations in these mother and their offspring are warranted.

Methods

In an observational cohort study we included 331 pregnant women from Granada, Spain. The mothers were categorized into four groups according to BMI and their GD status; overweight (n:56), obese (n:64), GD (n:79), and healthy normal weight controls (n:132). We assessed maternal growth and nutritional biomarkers at 24 weeks (n = 269), 34 weeks (n = 310) and at delivery (n = 310) and the perinatal characteristics including cord blood biomarkers.

Results

Obese and GD mothers had significantly lower weight gain during pregnancy and infant birth weight, waist circumference, and placental weight were higher in the obese group, including a significantly increased prevalence of macrosomia. Except for differences in markers of glucose metabolism (glucose, HbA1c, insulin and uric acid) we found at some measures that overweight and/or obese mothers had lower levels of transferrin saturation, hemoglobin, Vitamin B12 and folate and higher levels of C-reactive protein, erythrocyte sedimentation rate, ferritin, and cortisol. GD mothers had similar differences in hemoglobin and C-reactive protein but higher levels of folate. The latter was seen also in cord blood.

Conclusions

We identified several metabolic alterations in overweight, obese and GD mothers compared to controls. Together with the observed differences in infant anthropometrics, these may be important biomarkers in future research regarding the programming of health and disease in children.

Trial registration

The trial was registered at clinicaltrials.gov, identifier (NCT01634464).

Barker DJ. The effect of nutrition of the fetus and neonate on cardiovascular disease in adult life. Proc Nutr Soc. 1992;51(2):135–44.CrossRefPubMed

Symonds ME, Stephenson T, Gardner DS, Budge H. Long-term effects of nutritional programming of the embryo and fetus: mechanisms and critical windows. Reprod Fertil Dev. 2007;19(1):53–63.CrossRefPubMed

Barker DJ. The fetal and infant origins of disease. Eur J Clin Invest. 1995;25(7):457–63.CrossRefPubMed

Hanley B, Dijane J, Fewtrell M, Grynberg A, Hummel S, Junien C, et al. Metabolic imprinting, programming and epigenetics—a review of present priorities and future opportunities. Br J Nutr. 2010;104 Suppl 1:S1–S25. doi:10.1017/S0007114510003338.CrossRefPubMed

Shaw J. Epidemiology of childhood type 2 diabetes and obesity. Pediatr Diabetes. 2007;8 Suppl 9:7–15. doi:10.1111/j.1399-5448.2007.00329.x.CrossRefPubMed

Sharashova EE, Anda EE, Grjibovski AM. Early pregnancy body mass index and spontaneous preterm birth in northwest Russia: a registry-based study. BMC Pregnancy Childbirth. 2014;14:303. doi:10.1186/1471-2393-14-303.CrossRefPubMedPubMedCentral

Taebi M, Sadat Z, Saberi F, Kalahroudi MA. Early pregnancy waist-to-hip ratio and risk of preeclampsia: a prospective cohort study. Hypertens Res. 2015;38(1):80–3. doi:10.1038/hr.2014.133.CrossRefPubMed

Amemiya S, Dobashi K, Urakami T, Sugihara S, Ohzeki T, Tajima N. Metabolic syndrome in youths. Pediatr Diabetes. 2007;8 Suppl 9:48–54. doi:10.1111/j.1399-5448.2007.00332.x.CrossRefPubMed

Van Lieshout RJ. Role of maternal adiposity prior to and during pregnancy in cognitive and psychiatric problems in offspring. Nutr Rev. 2013;71 Suppl 1:S95–S101. doi:10.1111/nure.12059.CrossRefPubMed

10.

Rizzo GS, Sen S. Maternal obesity and immune dysregulation in mother and infant: A review of the evidence. Paediatr Respir Rev. 2014. doi:10.1016/j.prrv.2014.10.005.

11.

Fall CH. Evidence for the intra-uterine programming of adiposity in later life. Ann Hum Biol. 2011;38(4):410–28. doi:10.3109/03014460.2011.592513.CrossRefPubMedPubMedCentral

12.

Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9945):766–81. doi:10.1016/s0140-6736(14)60460-8.CrossRefPubMedPubMedCentral

13.

Stenninger E, Flink R, Eriksson B, Sahlen C. Long-term neurological dysfunction and neonatal hypoglycaemia after diabetic pregnancy. Arch Dis Child Fetal Neonatal Ed. 1998;79(3):F174–9.CrossRefPubMedPubMedCentral

14.

Larque E, Ruiz-Palacios M, Koletzko B. Placental regulation of fetal nutrient supply. Curr Opin Clin Nutr Metab Care. 2013;16(3):292–7. doi:10.1097/MCO.0b013e32835e3674.CrossRefPubMed

15.

Starling AP, Brinton JT, Glueck DH, Shapiro AL, Harrod CS, Lynch AM, et al. Associations of maternal BMI and gestational weight gain with neonatal adiposity in the healthy start study. Am J Clin Nutr. 2015;101(2):302–9. doi:10.3945/ajcn.114.094946.CrossRefPubMedPubMedCentral

16.

Gueant JL, Namour F, Gueant-Rodriguez RM, Daval JL. Folate and fetal programming: a play in epigenomics? Trends Endocrinol Metab. 2013;24(6):279–89. doi:10.1016/j.tem.2013.01.010.CrossRefPubMed

17.

Sarr O, Yang K, Regnault TR. In utero programming of later adiposity: the role of fetal growth restriction. J Pregnancy. 2012;2012:134758. doi:10.1155/2012/134758.CrossRefPubMedPubMedCentral

18.

Reichetzeder C, Chen H, Foller M, Slowinski T, Li J, Chen YP, et al. Maternal vitamin D deficiency and fetal programming—lessons learned from humans and mice. Kidney Blood Press Res. 2014;39(4):315–29. doi:10.1159/000355809.CrossRefPubMed

19.

Georgieff MK, Landon MB, Mills MM, Hedlund BE, Faassen AE, Schmidt RL, et al. Abnormal iron distribution in infants of diabetic mothers: spectrum and maternal antecedents. J Pediatr. 1990;117(3):455–61.CrossRefPubMed

20.

Garcia-Valdes L, Campoy C, Hayes H, Florido J, Rusanova I, Miranda MT, et al. The impact of maternal obesity on iron status, placental transferrin receptor expression and hepcidin expression in human pregnancy. Int J Obes (Lond). 2015;39(4):571–8. doi:10.1038/ijo.2015.3.CrossRef

21.

Long NM, Rule DC, Zhu MJ, Nathanielsz PW, Ford SP. Maternal obesity upregulates fatty acid and glucose transporters and increases expression of enzymes mediating fatty acid biosynthesis in fetal adipose tissue depots. J Anim Sci. 2012;90(7):2201–10. doi:10.2527/jas.2011-4343.CrossRefPubMed

22.

Hibbeln JR, Davis JM, Steer C, Emmett P, Rogers I, Williams C, et al. Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. Lancet. 2007;369(9561):578–85. doi:10.1016/S0140-6736(07)60277-3.CrossRefPubMed

23.

National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes. 1979;28(12):1039–57.CrossRef

24.

Metzger BE. Summary and recommendations of the third international workshop-conference on gestational diabetes mellitus. Diabetes. 1991;40 Suppl 2:197–201.CrossRefPubMed

25.

Santacruz A, Collado MC, Garcia-Valdes L, Segura MT, Martin-Lagos JA, Anjos T, et al. Gut microbiota composition is associated with body weight, weight gain and biochemical parameters in pregnant women. Br J Nutr. 2010;104(1):83–92. doi:10.1017/s0007114510000176.CrossRefPubMed

26.

Torres-Espínola FJ, Altmäe S, Segura MT, Jerez A, Anjos T, Chisaguano M, et al. Maternal PPARG Pro12Ala polymorphism is associated with infant's neurodevelopmental outcomes at 18 months of age. Early Hum Dev. 2015;91(8):457–62.CrossRefPubMed

27.

Uhl O, Demmelmair H, Segura MT, Florido J, Rueda R, Campoy C, et al. Effects of obesity and gestational diabetes mellitus on placental phospholipids. Diabetes Res Clin Pract. 2015;109(2):364–71. doi:10.1016/j.diabres.2015.05.032.CrossRefPubMed

28.

Martino J, Sebert S, Segura MT, Garcia-Valdes L, Florido J, Padilla MC et al. Maternal body weight and gestational diabetes differentially influence placental and pregnancy outcomes. J Clin Endocrinol Metab. 2015:jc20152590. doi:10.1210/jc.2015-2590.

29.

American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2004;27 Suppl 1:S88–90.

30.

Siega-Riz AM, Gray GL. Gestational weight gain recommendations in the context of the obesity epidemic. Nutr Rev. 2013;71 Suppl 1:S26–30. doi:10.1111/nure.12074.CrossRefPubMed

31.

Koletzko B, Symonds ME, Olsen SF. Programming research: where are we and where do we go from here? Am J Clin Nutr. 2011;94(6 Supp):2036s–43s. doi:10.3945/ajcn.111.018903.CrossRefPubMed

32.

Cao C, O’Brien KO. Pregnancy and iron homeostasis: an update. Nutr Rev. 2013;71(1):35–51. doi:10.1111/j.1753-4887.2012.00550.x.CrossRefPubMed

33.

Georgieff MK. The role of iron in neurodevelopment: fetal iron deficiency and the developing hippocampus. Biochem Soc Trans. 2008;36(Pt 6):1267–71.CrossRefPubMedPubMedCentral

34.

Laillou A, Yakes E, Le TH, Wieringa FT, Le BM, Moench-Pfanner R, et al. Intra-individual double burden of overweight and micronutrient deficiencies among Vietnamese women. PLoS One. 2014;9(10), e110499. doi:10.1371/journal.pone.0110499.CrossRefPubMedPubMedCentral

35.

Molloy AM, Kirke PN, Brody LC, Scott JM, Mills JL. Effects of folate and vitamin B12 deficiencies during pregnancy on fetal, infant, and child development. Food Nutr Bull. 2008;29(2 Suppl):S101–11. discussion S12–5.CrossRefPubMed

36.

Rush EC, Katre P, Yajnik CS. Vitamin B12: one carbon metabolism, fetal growth and programming for chronic disease. Eur J Clin Nutr. 2014;68(1):2–7. doi:10.1038/ejcn.2013.232.CrossRefPubMed

37.

Siddiqua TJ, Ahmad SM, Ahsan KB, Rashid M, Roy A, Rahman SM et al. Vitamin B12 supplementation during pregnancy and postpartum improves B12 status of both mothers and infants but vaccine response in mothers only: a randomized clinical trial in Bangladesh. Eur J Nutr. 2015. doi:10.1007/s00394-015-0845-x.

38.

Araujo JR, Correia-Branco A, Moreira L, Ramalho C, Martel F, Keating E. Folic acid uptake by the human syncytiotrophoblast is affected by gestational diabetes, hyperleptinemia, and TNF-alpha. Pediatr Res. 2013;73(4 Pt 1):388–94. doi:10.1038/pr.2013.14.CrossRefPubMed

39.

Bastard JP, Maachi M, Lagathu C, Kim MJ, Caron M, Vidal H, et al. Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw. 2006;17(1):4–12.PubMed

40.

Segovia SA, Vickers MH, Gray C, Reynolds CM. Maternal obesity, inflammation, and developmental programming. Biomed Res Int. 2014;2014:418975. doi:10.1155/2014/418975.CrossRefPubMedPubMedCentral

41.

Koletzko B, Brands B, Poston L, Godfrey K, Demmelmair H. Early nutrition programming of long-term health. Proc Nutr Soc. 2012;71(3):371–8. doi:10.1017/s0029665112000596.CrossRefPubMed

42.

Wallace JM, Horgan GW, Bhattacharya S. Placental weight and efficiency in relation to maternal body mass index and the risk of pregnancy complications in women delivering singleton babies. Placenta. 2012;33(8):611–8. doi:10.1016/j.placenta.2012.05.006.CrossRefPubMed

Title: Maternal, fetal and perinatal alterations associated with obesity, overweight and gestational diabetes: an observational cohort study (PREOBE)
Authors: Staffan K. Berglund
Luz García-Valdés
Francisco J Torres-Espinola
Mª Teresa Segura
Cristina Martínez-Zaldívar
María J. Aguilar
Ahmad Agil
Jose A. Lorente
Jesús Florido
Carmen Padilla
Signe Altmäe
Acensión Marcos
M. Carmen López-Sabater
Cristina Campoy
on behalf of the PREOBE team
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-016-2809-3

At a glance: The STEP trials

Springer Medicine

Maternal, fetal and perinatal alterations associated with obesity, overweight and gestational diabetes: an observational cohort study (PREOBE)

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2016

The Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) is more useful than pre-existing laboratory tests for predicting hazardous drinking: a cross-sectional study

Study protocol: combining experimental methods, econometrics and simulation modelling to determine price elasticities for studying food taxes and subsidies (The Price ExaM Study)

Association between high school students’ cigarette smoking, asthma and related beliefs: a population-based study

The role of socio-economic status in depression: results from the COURAGE (aging survey in Europe)

Awareness, treatment and control of type 2 diabetes among Chinese elderly and its changing trend for past decade

Halo and spillover effect illustrations for selected beneficial medical devices and drugs