Background Obese pregnant women have exaggerated hyperlipidaemia, increased insulin resistance and poorer endothelial function which may be related to their increased risk of adverse obstetric outcomes. However lean and obese women gain similar fat mass during pregnancy so the underlying cause of the diverse metabolic response to pregnancy is unclear.
Hypothesis The distribution of adipose tissue either prior to or accrued during pregnancy determines maternal metabolic adaptation to pregnancy.
Method Women (n=60) were recruited at antenatal booking; 30 with body mass index (BMI) ≥30 kg/m2 and 30 with BMI <30 kg/m2. They were classified, based on a waist circumference of 80 cm, into ‘apples’ (central fat distribution) or ‘pears’ (lower body fat distribution). Plasma markers of metabolic pathways were assessed at booking.
Results All obese women were apples and showed the metabolic characteristics previously described for obese pregnancy. Non-obese apples (NOA, n=13) had thicker subcutaneous (mean (SD) NOA 22.0 (8.1) vs NOP 17.4 (5.2) mm, p=0.011) and visceral (12.7 (4.0) vs 7.8 (2.3) mm, p=0.001) fat (assessed by ultrasound) and higher plasma log C reactive protein (CRP) levels (0.69 (0.31) vs 0.32 (0.35), p=0.006) than non-obese pears (NOP, n=17). The difference in visceral fat thickness and CRP was maintained after adjustment for booking BMI.
Conclusion Lean women with a central fat distribution have a pronounced pro-inflammatory status at booking and may be susceptible to a poor metabolic adaptation to pregnancy as in obesity.
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