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

Rachel A Tinius, Kristin Yoho, Maire M Blankenship, Jill M Maples, Rachel A Tinius, Kristin Yoho, Maire M Blankenship, Jill M Maples

Abstract

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.

Keywords: inflammation; insulin resistance; metabolic rate; postnatal.

Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

© 2021 Tinius et al.

Figures

Figure 1
Figure 1
Relative resting metabolic rate and insulin resistance are negatively correlated at 4-6 months postpartum
Figure 2
Figure 2
Postpartum weight retention is positively correlated with metabolic outcomes including (A) insulin resistance, (B) inflammation, (C) triglycerides, and (D) carbohydrate oxidation.

References

    1. Reece EA, Leguizamon G, Wiznitzer A. Gestational diabetes: the need for a common ground. Lancet. 2009;373(9677):1789–1797. doi:10.1016/S0140-6736(09)60515-8
    1. Chan JC, Malik V, Jia W, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301(20):2129–2140. doi:10.1001/jama.2009.726
    1. Godfrey KM, Reynolds RM, Prescott SL, et al. Influence of maternal obesity on the long-term health of offspring. Lancet Diabetes Endocrinol. 2017;5(1):53–64. doi:10.1016/S2213-8587(16)30107-3
    1. Pastore I, Chiefari E, Vero R, Brunetti A. Postpartum glucose intolerance: an updated overview. Endocrine. 2017.
    1. Rasmussen KM, Catalano PM, Yaktine AL. New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know. Curr Opin Obstet Gynecol. 2009;21(6):521–526. doi:10.1097/GCO.0b013e328332d24e
    1. Dalenius K, Brindley P, Smith B, Reinold C, Grummer-Strawn L. Pregnancy Nutrition Surveillance 2010 Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2012.
    1. Rooney BL, Schauberger CW, Mathiason MA. Impact of perinatal weight change on long-term obesity and obesity-related illnesses. Obstet Gynecol. 2005;106(6):1349–1356. doi:10.1097/01.AOG.0000185480.09068.4a
    1. Lain KY, Catalano PM. Metabolic changes in pregnancy. Clin Obstet Gynecol. 2007;50(4):938–948. doi:10.1097/GRF.0b013e31815a5494
    1. Wendland CL. The vanishing mother: cesarean section and “evidence-based obstetrics”. Med Anthropol Q. 2007;21(2):218–233. doi:10.1525/maq.2007.21.2.218
    1. Pereira LCR, Elliott SA, McCargar LJ, et al. The influence of energy metabolism on postpartum weight retention. Am J Clin Nutr. 2019;109(6):1588–1599. doi:10.1093/ajcn/nqy389
    1. Berggren EK, Presley L, Amini SB, Hauguel-de Mouzon S, Catalano PM. Are the metabolic changes of pregnancy reversible in the first year postpartum? Diabetologia. 2015;58(7):1561–1568. doi:10.1007/s00125-015-3604-x
    1. Saade GR. Pregnancy as a window to future health. Obstet Gynecol. 2009;114(5):958–960. doi:10.1097/AOG.0b013e3181bf5588
    1. Tinius RA, Blankenship MM, Furgal KE, et al. Metabolic flexibility is impaired in women who are pregnant and overweight/obese and related to insulin resistance and inflammation. Metabolism. 2020;104:154142. doi:10.1016/j.metabol.2020.154142
    1. Frayn KN. Calculation of substrate oxidation rates in vivo from gaseous exchange. J Appl Physiol Respir Environ Exerc Physiol. 1983;55(2):628–634. doi:10.1152/jappl.1983.55.2.628
    1. Huston presley L, Wong WW, Roman NM, Amini SB, Catalano PM. Anthropometric estimation of maternal body composition in late gestation. Obstet Gynecol. 2000;96(1):33–37. doi:10.1016/S0029-7844(00)00857-7
    1. Marshall NE, Murphy EJ, King JC, et al. Comparison of multiple methods to measure maternal fat mass in late gestation. Am J Clin Nutr. 2016;103(4):1055–1063. doi:10.3945/ajcn.115.113464
    1. Widen EM, Gallagher D. Body composition changes in pregnancy: measurement, predictors and outcomes. Eur J Clin Nutr. 2014;68(6):643–652. doi:10.1038/ejcn.2014.40
    1. Qiu C, Gelaye B, Zhong QY, Enquobahrie DA, Frederick IO, Williams MA. Construct validity and factor structure of the Pittsburgh Sleep Quality Index among pregnant women in a Pacific-Northwest cohort. Sleep Breath. 2016;20(1):293–301. doi:10.1007/s11325-016-1313-4
    1. Ceneters for Disease Control. Questionnaires: breastfeeding and Infant Feeding Practices. 5 month postpartum survey. Available from: . Accessed November4, 2020.
    1. Gibson J, McKenzie-McHarg K, Shakespeare J, Price J, Gray R. A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatr Scand. 2009;119(5):350–364. doi:10.1111/j.1600-0447.2009.01363.x
    1. Butte NF, Hopkinson JM, Mehta N, Moon JK, Smith EO. Adjustments in energy expenditure and substrate utilization during late pregnancy and lactation. Am J Clin Nutr. 1999;69(2):299–307. doi:10.1093/ajcn/69.2.299
    1. Melzer K, Schutz Y, Soehnchen N, et al. Prepregnancy body mass index and resting metabolic rate during pregnancy. Ann Nutr Metab. 2010;57(3–4):221–227. doi:10.1159/000322369
    1. Kopp-Hoolihan LE, van Loan MD, Wong WW, King JC. Longitudinal assessment of energy balance in well-nourished, pregnant women. Am J Clin Nutr. 1999;69(4):697–704. doi:10.1093/ajcn/69.4.697
    1. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018. NCHS Data Brief, No 360. Hyattsville, MD: National Center for Health Statistics; 2020.
    1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2020.
    1. Ravussin E. Low resting metabolic rate as a risk factor for weight gain: role of the sympathetic nervous system. Int J Obes Relat Metab Disord. 1995;19(Suppl 7):S8–S9.
    1. Leddy MA, Power ML, Schulkin J. The impact of maternal obesity on maternal and fetal health. Rev Obstet Gynecol. 2008;1(4):170–178.
    1. Caballero AE. Endothelial dysfunction in obesity and insulin resistance: a road to diabetes and heart disease. Obes Res. 2003;11(11):1278–1289. doi:10.1038/oby.2003.174
    1. Motil KJ, Montandon CM, Garza C. Basal and postprandial metabolic rates in lactating and nonlactating women. Am J Clin Nutr. 1990;52(4):610–615. doi:10.1093/ajcn/52.4.610
    1. Breastfeeding Report Card. Centers for Disease Control; 2018. Available from: . Accessed May31, 2021.
    1. Stuebe AM, Rich-Edwards JW. The reset hypothesis: lactation and maternal metabolism. Am J Perinatol. 2009;26(1):81–88. doi:10.1055/s-0028-1103034
    1. Maciak S, Sawicka D, Sadowska A, et al. Low basal metabolic rate as a risk factor for development of insulin resistance and type 2 diabetes. BMJ Open Diabetes Res Care. 2020;8(1):1. doi:10.1136/bmjdrc-2020-001381
    1. Liu J, Song G, Meng T, Zhao G, Guo S. Weight retention at six weeks postpartum and the risk of gestational diabetes mellitus in a second pregnancy. BMC Pregnancy Childbirth. 2019;19(1):272. doi:10.1186/s12884-019-2423-3
    1. Brooks GC, Blaha MJ, Blumenthal RS. Relation of C-reactive protein to abdominal adiposity. Am J Cardiol. 2010;106(1):56–61. doi:10.1016/j.amjcard.2010.02.017
    1. Zota AR, Geller RJ, Romano LE, et al. Association between persistent endocrine-disrupting chemicals (PBDEs, OH-PBDEs, PCBs, and PFASs) and biomarkers of inflammation and cellular aging during pregnancy and postpartum. Environ Int. 2018;115:9–20. doi:10.1016/j.envint.2018.02.044
    1. Perng W, Rifas-Shiman SL, Rich-Edwards JW, Stuebe AM, Oken E. Inflammation and weight gain in reproductive-aged women. Ann Hum Biol. 2016;43(1):91–95. doi:10.3109/03014460.2014.968619
    1. Puhkala J, Luoto R, Ahotupa M, Raitanen J, Vasankari T. Postpartum weight retention is associated with elevated ratio of oxidized LDL lipids to HDL-cholesterol. Lipids. 2013;48(12):1227–1235. doi:10.1007/s11745-013-3852-9
    1. Galgani J, Ravussin E. Energy metabolism, fuel selection and body weight regulation. Int J Obes. 2008;32(Suppl 7):S109–119. doi:10.1038/ijo.2008.246
    1. Rong K, Yu K, Han X, et al. Pre-pregnancy BMI, gestational weight gain and postpartum weight retention: a meta-analysis of observational studies. Public Health Nutr. 2015;18(12):2172–2182. doi:10.1017/S1368980014002523
    1. Chin JR, Krause KM, Ostbye T, Chowdhury N, Lovelady CA, Swamy GK. Gestational weight gain in consecutive pregnancies. Am J Obstet Gynecol. 2010;203(3):279 e271–276. doi:10.1016/j.ajog.2010.06.038
    1. Rooney BL, Schauberger CW. Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol. 2002;100(2):245–252. doi:10.1016/s0029-7844(02)02125-7
    1. Kew S, Ye C, Hanley AJ, et al. Cardiometabolic implications of postpartum weight changes in the first year after delivery. Diabetes Care. 2014;37(7):1998–2006. doi:10.2337/dc14-0087
    1. ACOG Committee Opinion. No. 736: optimizing Postpartum Care. Obstet Gynecol. 2018;131(5):e140–e150. doi:10.1097/AOG.0000000000002633

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj