Elsevier

Nutrition

Volume 38, June 2017, Pages 20-27
Nutrition

Applied nutritional investigation
Association between prepregnancy obesity and metabolic risk in Chilean premenopausal women 10 y postpartum

https://doi.org/10.1016/j.nut.2017.01.003Get rights and content

Highlights

  • Few studies, all conducted in developed countries, have previously evaluated the relationship between prepregnancy obesity and excessive gestational weight gain and future metabolic risk beyond adiposity.

  • The present study evaluated the association between prepregnancy obesity, excessive gestational weight gain, or both and maternal metabolic complications 10 y postpartum in a sample of premenopausal Chilean women from low- and middle-income communities.

  • The results demonstrated that prepregnancy obesity was positively associated with increased insulin resistance, metabolic syndrome, and hyperglycemia.

Abstract

Objectives

One of every four pregnant women in Chile is obese. Gestational obesity is associated with maternal metabolic complications in pregnancy (e.g., gestational diabetes, preeclampsia), but to our knowledge, there is little evidence on relationships with future metabolic risk. The aim of this study was to evaluate the association between prepregnancy obesity (prepregnancy body mass index ≥30 kg/m2) or excessive gestational weight gain (GWG; according to the 2009 recommendations from the Institute of Medicine), and maternal metabolic complications 10 y postpartum in premenopausal Chilean women.

Methods

A prospective study was conducted. In 2006, 1067 Chilean mothers of children born in 2002—participants of the GOCS (Growth and Obesity Cohort Study)—were recruited. Mothers completed a questionnaire concerning sociodemographic, anthropometric, and pregnancy characteristics. Of the sample, 402 women were randomly selected to participate in a study related to the determinants of breast cancer risk in 2012. At follow-up, anthropometry, blood pressure, and fasting labs were measured. Complete data was available for 366 women.

Results

Thirty-two percent of mothers had prepregnancy overweight/obesity and 39.1% had excessive GWG. In adjusted models, prepregnancy obesity was positively associated with increased insulin resistance (odds ratio [OR], 18; 95% confidence interval [CI], 5.2–62.7), metabolic syndrome (OR, 3.3; 95% CI, 1.3–8.3), and hyperglycemia (OR, 3; 95% CI, 1.1–8.6). Prepregnancy overweight/obesity was associated with increased risk for insulin resistance, metabolic syndrome, abdominal obesity, low high-density lipoprotein cholesterol, and hypertriglyceridemia (P < 0.05). Excessive GWG was not associated with metabolic risk in the main model but was found to be positively associated in models with correction of weight by possible recall bias.

Conclusions

Gestational obesity was associated with maternal metabolic alterations 10 y postpartum. Prevention strategies for chronic diseases should consider prepregnancy obesity as a modifiable risk factor for future metabolic health.

Introduction

Obesity is considered a worldwide epidemic. Every year, approximately 2.6 million people die as a result of excess weight, which disproportionally affects women [1], [2]. In 2010, the Chilean Ministry of Health estimated that 31% of women between the ages of 15 and 44 y were overweight and 20% were obese [3]. Additionally, the prevalence of overweight/obesity among pregnant women who are beneficiaries of the Chilean public health system reached 59% in 2013, with one of every four women considered obese [4]. Prepregnancy obesity (prepregnancy body mass index [BMI] ≥30 kg/m2) or excessive gestational weight gain (GWG; above recommendations established by the Institute of Medicine [IOM]) [5] are the most important factors in Western societies related to perinatal outcomes as gestational diabetes, preeclampsia, or macrosomia [5], [6], [7], [8], [9].

Prepregnancy obesity and excessive GWG are independently and positively related to maternal retention of weight and fat postpartum and obesity in the short and long terms [10], [11], [12], [13], [14]. However, to our knowledge, few studies, all conducted in developed countries, have previously evaluated the relationship between prepregnancy obesity and excessive GWG and future metabolic risk beyond adiposity. One study showed that after 15 y, prepregnancy obesity was related to increased risk for type 2 diabetes, metabolic syndrome (MetS), heart disease, hypertension, and dyslipidemia [15]. This relationship could be explained because among pregnant women who are obese before pregnancy, fat preferentially deposits in central locations, which could be associated with future metabolic complications [16], [17]. In relation to excessive GWG, three studies found no association with metabolic risk factors such as insulin resistance (IR), lipids, glucose, and MetS [13], [15], [18].

Thus, the objective of the present study was to evaluate in a Latin American country that has undergone a very rapid nutrition transition, the association between prepregnancy obesity or/and excessive GWG and maternal metabolic complications (hyperglycemia, dyslipidemia, IR, and MetS), 10 y postpartum in a sample of premenopausal Chilean women from low- and middle-income communities.

Section snippets

Study design and participants

The present study is a prospective cohort of the mothers of participant children from the GOCS study. The objectives and methods of the GOCS study have been described elsewhere [19], [20]. In brief, GOCS was an ambispective cohort started in 2006 of 1196 children born in 2002, who attended public daycare centers (JUNJI) in six neighborhoods in the southeast area of Santiago, Chile. Data on participating children were collected retrospectively from pregnancy to 2006 and then prospectively

Ethical considerations

Approval for the GOCS and DERCAM studies were obtained from Ethics Committee at Institute of Nutrition and Food Technology (INTA), University of Chile. All participants signed written consent forms.

Results

The final sample consisted of 366 premenopausal women (Fig. 1). Participants included in this study were similar to those excluded (n = 830) with respect to age at delivery, smoking, GWG, parity, age, and anthropometric and metabolic variables (P > 0.05; data not shown). Women who were excluded differed from those included in educational level (elementary education: 39.8 versus 30%), child's birth weight (3412 versus 3349 g) and birth length (50.1 versus 49.6 cm; P < 0.05, data not shown).

At

Discussion

The present study demonstrated that in women from a Latin American country with a rapid nutrition transition, both prepregnancy overweight and obesity were associated with maternal metabolic risk 10 y postpartum. This relationship remained even after adjusting for sociodemographic and gyneco-obstetric characteristics. Rooney et al. also found that pregnant women with prepregnancy obesity had a ninefold greater risk for type 2 diabetes and a fivefold increase in risk for coronary heart disease,

Conclusion

Gestational obesity was associated with greater metabolic risk to mothers 10 y postpartum. To our knowledge, this is the first study conducted in a country that has undergone a very rapid nutrition transition and suggests that prevention strategies for chronic diseases should consider early life risk factors, particularly those targeting prepregnancy obesity.

Acknowledgments

The authors acknowledge GOCS and DERCAM field workers, especially to the coordinators Daniela González and Ángela Martínez. They also acknowledge GOCS and DERCAM study participants.

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  • This work was supported by FONDECYT 1130277, 11100238, and 1120326.

    MLG and CZ designed the research, analyzed the data, and wrote the manuscript. The authors were final reviewers for scientific content and they all read and approved the final manuscript. The authors have no conflicts of interest to declare.

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