Elsevier

Metabolism

Volume 69, April 2017, Pages 112-119
Metabolism

Clinical Science
First and second trimester gestational weight gains are most strongly associated with cord blood levels of hormones at delivery important for glycemic control and somatic growth

https://doi.org/10.1016/j.metabol.2017.01.019Get rights and content

Abstract

Background

Excessive gestational weight gain (GWG) during pregnancy is associated with adverse outcomes for mothers and offspring. Early, mid, and late pregnancy GWGs have different associations with fetal growth and later life adiposity, but associations with cord blood hormones, which might predict later health, are not well studied.

Methods

In 978 pregnant women from the pre-birth Project Viva cohort, we calculated trimester-specific GWG using clinically recorded prenatal weights. Outcomes were levels of umbilical cord blood hormones related to fetal and postnatal growth. We used linear regression models adjusted for maternal race/ethnicity, pre-pregnancy BMI, parity, education, pregnancy smoking status and child sex; 2nd and 3rd trimester models were additionally adjusted for GWG in prior trimesters.

Results

Mean ± SD pre-pregnancy BMI was 24.9 ± 5.5 kg/m2, 30% were non-white, and 63% were college graduates. Mean ± SD cord blood hormone levels were insulin-like growth factor [IGF]-1 (56.4 ± 24.3 ng/mL), IGF-2 (408.5 ± 92.7 ng/mL), IGFBP-3 (1084 ± 318 ng/mL), insulin (6.5 ± 7.2 uU/mL), C-peptide (1.0 ± 0.6 ng/mL), leptin (9.0 ± 6.6 ng/mL) and adiponectin (28.7 ± 6.8 μg/mL). Mean ± SD 1st, 2nd and 3rd trimester GWG rates were 0.22 ± 0.22, 0.49 ± 0.19 and 0.46 ± 0.22 kg/wk. Greater 1st trimester GWG (per 0.2 kg/wk) was associated with higher insulin (0.5 uU/mL; 95% CI 0.1, 0.9) and C-peptide (0.06 ng/mL; 95% CI 0.02, 0.09) and lower adiponectin (−0.4 μg/mL; 95% CI − 0.9, 0.0). Greater 2nd trimester GWG (per 0.2 kg/wk) was associated with higher IGF-1 (2.3 ng/mL; 95% CI 0.6, 4.0), IGF-2 (7.9 ng/mL; 95% CI 1.2, 14.6), IGFBP-3 (41.6 ng/mL; 95% CI 19.4, 63.7) and leptin (0.9 ng/mL; 0.4, 1.4). 3rd trimester GWG was not associated with cord blood hormones.

Conclusion

1st trimester weight gain appears to matter more for cord blood hormones related to offspring glucose/insulin regulation, whereas 2nd trimester gain matters more for hormones related to growth and adiposity.

Introduction

Maternal weight gain during pregnancy is an important determinant of birth outcomes. Gestational weight gain (GWG) is directly associated with birth weight for gestation length, a marker of fetal growth, which [1], [2] is directly associated with child adiposity and long term risks of cancer and cardiometabolic health [3], [4], [5]. By alteration of the intrauterine environment, the amount and the timing of weight gained during pregnancy not only influence fetal growth [6], [7], [8], [9], [10] but also may result in persistent programming of child health [6], [7], [8], [11], as has been shown previously with other intrauterine exposures such as maternal smoking and gestational diabetes mellitus [12], [13].

Early, mid, and late pregnancy GWGs have different associations with fetal growth. Greater GWG in early pregnancy represents mainly maternal fat gain and might influence placental nutrient transfer differently than later GWG, which reflects fetal and placental growth and maternal fluid expansion in addition to maternal fat gain. Late pregnancy GWG has been consistently reported to be associated with birth weight [7], [11]. In our cohort, rates of GWG in all 3 trimesters were associated with higher fetal growth, with the greatest effect of 2nd trimester GWG [6]. We have also found that greater early and mid-pregnancy weight gain predicted offspring adiposity in mid-childhood, whereas 3rd trimester GWG did not [6], similar to results from other cohorts [8].

One of the pathways by which GWG might influence offspring growth and development is through changes in the regulation of mitogenic hormones and adipokines, including insulin, the insulin-like growth factor (IGF) axis, adiponectin, and leptin. We are not aware of prior studies that examined associations of trimester-specific GWG with multiple cord blood hormones, which might predict later health. Therefore, we conducted the present study to examine the extent to which trimester-specific rates of GWG are associated with cord blood hormone levels.

Section snippets

Methods

Between 1999 and 2002 we recruited pregnant women at 8 obstetric offices of Atrius Harvard Vanguard Medical Associates, a multispecialty group practice in eastern Massachusetts [14]. Exclusion criteria included multiple gestation, inability to answer questions in English, gestational age  22 weeks at recruitment, and plans to move away from the study area before delivery. All participating women provided written informed consent, and institutional review boards reviewed and approved the project

Results

Of the 978 women included in this analysis, mean ± SD age at enrollment was 31.8 ± 5.2 years and pre-pregnancy BMI was 24.9 ± 5.5 kg/m2. At enrollment, 30% were non-white, 63% were college graduates, 45% were nulliparous, 92% were married or cohabitating, and 60% reported a household income of >$70,000 per year (Table 1). Mean ± SD 1st, 2nd and 3rd trimester GWG rates were 0.22 ± 0.22, 0.49 ± 0.19 and 0.46 ± 0.22 kg/wk. Rate of GWG for the whole pregnancy was strongly correlated with rate of GWG in the 1st

Discussion

In this prospective study of almost 1000 mother–infant pairs, we found that greater 1st trimester GWG was associated with higher insulin and c-peptide and lower adiponectin, whereas greater 2nd trimester GWG was associated with higher IGF-1, IGF-2, IGFBP-3, and leptin. 3rd trimester GWG was not associated with cord blood hormones. This pattern suggest that 1st trimester weight gain may impact glucose and insulin regulation, whereas 2nd trimester gain may impact fetal and postnatal growth.

Our

Authors' Contributions

SRS, EO, and MWG contributed to the conception and design of the study; SRS, CM, MWG, and EO contributed to the acquisition of the data; SRS, AF, MFH, CM, MWG, and EO and contributed to the interpretation of the data; SRS performed statistical analyses; SRS drafted the manuscript; SRS has primary responsibility for the final content. All authors have read, critically revised, and approved the final manuscript.

Funding

Project Viva is supported by the National Institutes of Health (R01HD034568). Dr. Oken is additionally supported by K24 HD069408 and P30 DK092924. Dr. Fleisch is additionally supported by K23ES024803. Dr. Mantzoros is additionally supported by K24 DK081913.

Conflicts of Interest

None.

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