Background
Methods
Study design and subjects
Ethics, consent and permissions
Data collection during pregnancy
Measure | Outcomes | Time of collection |
---|---|---|
Baseline recruitment information | Pre-gestational BMI, ethnicity, medical history, age, education, parity, smoking, ongoing supplements | Recruitment visit, 24 wk, and 34 wk |
Maternal anthropometrics | Weight, length, circumference of abdomen, waist etc., skinfold thickness of triceps, subscapularis etc.a
| 24 wk, 34 wk |
Bioimpedance | BMRa, impedancea, BMIa, FM/FMIa, FFM/FFMIa, body watera
| 24 wk, 34 wk |
Fetal ultrasound | Fetal anthropometricsa
| 24 wk, 34 wk |
Urine samples | Metabolomicsa
| 24 wk, 34 wk |
Fecal samples | Microbiotab, metabolomicsa
| 24 wk, near delivery |
Cheek cell sample | Microbiotaa, geneticsab, fatty acidsa
| 34 wk (mother), birth (infant) |
Food questionnaire | Quantitative and qualitative dietary analysesa
| 24 wk, 34 wk |
Placenta samples | Placental weight and circumference, Lipid profilea, phospholipidsa, gene expressiona, lipid peroxidation, pTfRb
| Delivery |
Lifestyle questionnaire | Lifestyle and physical activitya
| 24 wk |
Blood samples (Mother and cord blood) | Direct analyses: ESR, glucose, lipidsa, urea, creatinine, uric acid, bilirubin, iron status, folate, TSH, amylase, CRP, HbA1c, total protein, albumin, vit B12, insulin, cortisol, IGF1a, IGFBP1a, and lymphocyte subpopulationsa. Frozen serum/plasma: Hepcidinb, TfRb, adiponectina, resistina, leptin, interleukinsa, phospholipid profilesa, lipid peroxidationa, tocopherola, retinola. | 24 wk, 34 wk, delivery (mother and cord blood) |
Perinatal records | Gender, gestational age, Apgar, delivery mode, neonatal diagnoses/admission | – |
Infant anthropometrics | Birth weight, length, circumference of head, upper-arm, chest and waist, BMI, waist/height index, heel-knee, hip-knee | Birth |
Meconium | Microbiotaa
| Birth |
Breast milk | Fatty acidsa, vitaminsa
| day 1, day 7, day 30 |
Data collection at delivery
Laboratory analyses
Statistics
Results
Maternal characteristics and outcomes
Time |
N
| Normal weight n = 128
| Overweight n = 54
| Obese n = 52
| Gestational diabetes n = 76
|
P
| |
---|---|---|---|---|---|---|---|
Background | |||||||
Age (y) | 20 wk | 310 | 30.9 ± 4.2 | 32.0 ± 4.2 | 29.5 ± 7.8 | 33.7 ± 4.6a
| <0.001 |
Parity (>1) | – | 306 | 55 (43.3 %) | 24 (45.3 %) | 28 (53.8 %) | 35 (47.3 %) | 0.637 |
Smoking during pregnancy | – | 268 | 17 (14.4 %) | 5 (10.2 %) | 7 (15.6 %) | 7 (12.3 %) | 0.850 |
Alcohol during pregnancy | – | 270 | 6 (5.1 %) | 1 (2.0 %) | 1 (2.2 %) | 3 (5.3 %) | 0.692 |
Education at university-level | – | 306 | 68 (53.5 %) | 22 (41.5 %) | 11 (21.2 %)a
| 27 (36.5 %) | <0.001 |
Supplements during pregnancy | |||||||
Iron supplementation | – | 280 | 46 (36.2 %) | 13 (28.9 %) | 10 (21.7 %) | 28 (45.2 %) | 0.065 |
Folic acid supplementation | – | 260 | 115 (92.7 %) | 38 (84.4 %) | 32 (76.2 %)a
| 43 (87.8 %) | 0.036 |
B12 supplementation | – | 259 | 64 (51.6 %) | 22 (48.9 %) | 22 (52.4 %) | 35 (72.8 %)a
| 0.055 |
Anthropometrics | |||||||
Pre-gestational BMI (kg/m2) | 0 wk | 310 | 22.0 ± 1.7 | 23.7 ± 1.3a
| 33.3 ± 2.8a
| 27.7 ± 6.2a
| <0.001 |
Weight (kg) | 0 wk | 310 | 59.1 ± 5.6 | 72.3 ± 6.0a
| 87.3 ± 9.1a
| 72.5 ± 18.3a
| <0.001 |
delivery | 209 | 72.0 ± 8.8 | 82.2 ± 7.8a
| 94.8 ± 11.3a
| 77.9 ± 16.1a
| <0.001 | |
Weight gain during pregnancy (kg) | delivery | 209 | 12.5 ± 6.1 | 10.3 ± 5.2 | 7.2 ± 6.9a
| 6.9 ± 8.2a
| <0.001 |
Iron status | |||||||
Ferritin (μg/l) | 24 wk | 240 | 18.3 (10–26) | 18.3 (10–28) | 22.7 (16–41)a
| 23.0 (18–30) | 0.033 |
34 wk | 299 | 15.7 (9–21) | 12.0 (9–19) | 12.8 (9–18) | 16.4 (11–29) | 0.011 | |
delivery | 199 | 21.0 (16–33) | 19.6 (16–26) | 17.4 (15–22) | 22.0 (18–46) | 0.005 | |
TS (%) | 24 wk | 242 | 18.9 ± 8.6 | 16.6 ± 6.3 | 15.3 ± 5.4a
| 20.3 ± 7.7 | 0.009 |
34 wk | 300 | 17.1 ± 10.9 | 14.9 ± 7.9 | 12.5 ± 5.2a
| 19.0 ± 13.7 | 0.006 | |
delivery | 200 | 17.6 ± 12.4 | 16.4 ± 11.9 | 13.9 ± 6.0 | 17.4 ± 8.4 | 0.376 | |
Hb (g/l) | 24 wk | 222 | 12.6 ± 1.6 | 12.4 ± 1.7 | 12.1 ± 0.4 | 11.6 ± 0.8 | 0.136 |
34 wk | 288 | 11.8 ± 1.2 | 11.5 ± 1.5 | 11.6 ± 0.8 | 11.8 ± 1.1 | 0.421 | |
delivery | 199 | 12.6 ± 2.0 | 11.4 ± 1.4a
| 11.4 ± 1.4a
| 11.6 ± 1.7a
| <0.001 | |
MCV (fl) | 24 wk | 222 | 88.9 ± 4.4 | 88.9 ± 4.7 | 88.0 ± 4.1 | 89.3 ± 4.3 | 0.617 |
34 wk | 288 | 87.3 ± 5.5 | 87.0 ± 5.4 | 85.4 ± 4.1 | 86.6 ± 5.1 | 0.193 | |
delivery | 198 | 86.2 ± 6.9 | 84.6 ± 5.3 | 84.1 ± 5.3 | 87.7 ± 4.9 | 0.036 | |
Vitamins | |||||||
Vitamin B12 (pg/ml) | 24 wk | 59 | 321 ± 124 | 262 ± 76 | 309 ± 136 | 0.156 | |
34 wk | 87 | 257 ± 91 | 248 ± 68 | 307 ± 101 | 0.012 | ||
delivery | 59 | 312 ± 98 | 221 ± 73a
| 263 ± 90 | 0.037 | ||
Folate (ng/ml)b
| 24 wk | 242 | 15.3 (11.5–19.3) | 16.3 (10.5–19.7) | 14.4 (8.4–19.8) | 18.1 (13.4–20.0) | 0.212 |
34 wk | 300 | 14.8 (10.2–18.0) | 13.5 (7.4–19.2) | 11.4 (6.2–16.3)a
| 18.2 (12.3–20.0)a
| <0.001 | |
delivery | 201 | 14.2 (9.1–18.3) | 10.1 (6.0–17.4) | 7.3 (5.0–14.6)a
| 15.1 (9.6–19.0) | 0.001 | |
Other biomarkers | |||||||
Glucose (g/l) | 24 wk | 242 | 80.5 ± 16.6 | 87.3 ± 16.6 | 84.8 ± 16.7 | 97.2 ± 24.4a
| <0.001 |
34 wk | 301 | 86.7 ± 18.6 | 88.0 ± 17.7 | 89.6 ± 17.8 | 93.5 ± 23.5 | 0.119 | |
delivery | 201 | 82.7 ± 28.0 | 86.8 ± 23.7 | 96.9 ± 35.3 | 102.2 ± 33.8a
| 0.002 | |
Insulin (μU/ml) | 24 wk | 104 | 21.8 (6.6–39.1) | 36.5 (14.1–66.2) | 26.9 (16.9–54.3) | 21.0 (14.1–60.8) | 0.306 |
34 wk | 159 | 29.9 (12.9–51.4) | 38.9 (24.3–63.3) | 38.4 (22.8–71.0) | 24.5 (12.5–42.1) | 0.013 | |
delivery | 110 | 10.0 (5.4–15.7) | 14.6 (10.7–27.5)a
| 12.1 (6.7–23.0) | 0.008 | ||
HbA1c (%) | 24 wk | 196 | 4.2 (4.0–4.4) | 4.5 (4.2–4.9)a
| 4.8 (4.2–5.1)a
| 5.1 (4.6–5.3)a
| <0.001 |
34 wk | 258 | 4.5 (4.3–4.8) | 4.8 (4.4–5.4)a
| 5.0 (4.5–4.4)a
| 5.1 (4.7–5.5)a
| <0.001 | |
delivery | 180 | 4.6 (4.4–4.8) | 5.0 (4.7–4.3)a
| 5.2 (4.5–5.5)a
| 5.2 (4.9–4.5)a
| <0.001 | |
Uric acid (mg/dl) | 24 wk | 243 | 3.09 ± 0.62 | 3.06 ± 0.75 | 3.53 ± 0.72a
| 3.08 ± 0.51 | <0.001 |
34 wk | 301 | 3.62 ± 0.77 | 3.59 ± 0.91 | 3.76 ± 0.69 | 3.87 ± 1.04 | 0.186 | |
delivery | 200 | 4.55 ± 1.08 | 4.64 ± 1.41 | 4.64 ± 1.22 | 4.45 ± 0.96 | 0.843 | |
Creatinine (mg/dl) | 24 wk | 230 | 0.60 ± 0.14 | 0.59 ± 0.10 | 0.56 ± 0.10 | 0.58 ± 0.09 | 0.239 |
34 wk | 301 | 0.61 ± 0.11 | 0.71 ± 0.62 | 0.59 ± 0.11 | 0.66 ± 0.15 | 0.087 | |
delivery | 201 | 0.64 ± 0.11 | 0.69 ± 0.19 | 0.61 ± 0.13 | 0.68 ± 0.17 | 0.096 | |
TSH (ng/ml) | 24 wk | 241 | 1.65 (0.98–2.08) | 1.37 (1.06–2.18) | 1.65 (1.11–2.32) | 1.56 (1.17–2.50) | 0.888 |
34 wk | 299 | 1.39 (1.05–2.04) | 1.34 (1.08–1.98) | 1.59 (0.89–2.17) | 1.39 (1.04–2.07) | 0.954 | |
delivery | 200 | 2.24 (1.61–3.16) | 2.15 (1.66–2.88) | 2.09 (1.59–3.06) | 2.17 (1.43–2.92) | 0.781 | |
CRP (mg/dl) | 24 wk | 71 | 0.27 (0.16–0.34) | 0.42 (0.17–0.53)a
| 0.68 (0.35–0.90)a
| <0.001 | |
34 wk | 121 | 0.79 (0.43–1.2) | 0.65 (0.39–1.0)a
| 0.96 (0.66–2.5) | 0.005 | ||
delivery | 89 | 0.56 (0.27–0.82) | 0.45 (0.28–0.83)a
| 1.2 (0.52–2.9)a
| 0.042 | ||
ESR (mm) | 24 wk | 91 | 35.7 ± 16.7 | 47.6 ± 16.3a
| 47.7 ± 14.3a
| 49.4 ± 20.1a
| 0.020 |
34 wk | 136 | 47.9 ± 25.9 | 60.8 ± 12.4 | 55.0 ± 11.6 | 53.2 ± 19.0 | 0.118 | |
delivery | 103 | 39.6 ± 22.9 | 54.0 ± 22.9 | 47.3 ± 24.0 | 0.060 | ||
Cortisol (μg/dl) | 24 wk | 104 | 21.0 ± 6.2 | 18.3 ± 5.7 | 17.1 ± 5.0a
| 19.5 ± 5.4 | 0.050 |
34 wk | 160 | 22.6 ± 6.7 | 23.3 ± 6.4 | 23.3 ± 6.6 | 22.6 ± 7.1 | 0.934 | |
delivery | 112 | 57.5 ± 26.5 | 42.0 ± 15.2a
| 48.6 ± 18.2 | 0.007 |
Perinatal outcomes and cord blood analyses
N
| Normal weight n = 128
| Overweight n = 54
| Obese n = 52
| Gestational diabetes n = 76
|
P
| |
---|---|---|---|---|---|---|
Mode of delivery (vaginal) | 228 | 95 (87.2 %) | 31 (72.1 %) | 26 (72.2 %) | 28 (70.0 %)a
| 0.036 |
Placental weight (g) | 227 | 475 ± 112 | 512 ± 123 | 571 ± 133a
| 517 ± 116 | 0.001 |
Placental /fetal-ratio | 226 | 0.147 ± 0.03 | 0.158 ± 0.04 | 0.164 ± 0.04a
| 0.155 ± 0.03 | 0.030 |
Apgar score at 5 min | 234 | 10 (10–10) | 10 (10–10) | 10 (10–10) | 10 (10–10) | 0.357 |
Gestational age at birth (wk) | 287 | 39.4 ± 1.2 | 39.5 ± 1.4 | 39.8 ± 1.4 | 39.2 ± 1.5 | 0.169 |
Preterm birth (<37 wk) | 287 | 2 (1.6 %) | 1 (2.0 %) | 2 (4.2 %) | 1 (1.5 %) | 0.740 |
Post term birth (>42 wk) | 287 | 2 (1.6 %) | 0 (0 %) | 3 (6.3 %) | 1 (1.5 %) | 0.148 |
Infant gender (boy) | 298 | 61 (48.8 %) | 25 (48.1 %) | 29 (59.2 %) | 43 (59.7 %) | 0.327 |
Infant birth weight (kg) | 301 | 3.25 ± 0.39 | 3.29 ± 0.49 | 3.49 ± 0.51a
| 3.31 ± 0.46 | 0.020 |
Low birth weight (<2500 g) | 301 | 5 (3.9 %) | 2 (3.8 %) | 0 (0 %) | 2 (2.8 %) | 0.567 |
Macrosomia (>4000 g) | 301 | 5 (3.9 %) | 6 (11.3 %) | 8 (16.3 %)a
| 3 (4.2 %) | 0.016 |
Infant birth length (cm) | 236 | 50.4 ± 1.9 | 50.5 ± 1.6 | 51.0 ± 2.3 | 50.1 ± 2.4 | 0.192 |
Infant BMI (m/kg2) | 236 | 13.0 ± 1.2 | 13.0 ± 1.3 | 13.3 ± 1.4 | 13.3 ± 1.6 | 0.464 |
Infant waist/height index | 142 | 0.64 ± 0.04 | 0.64 ± 0.05 | 0.66 ± 0.05 | 0.67 ± 0.04a
| 0.023 |
Infant head circumference (cm) | 200 | 34.4 ± 1.3 | 34.5 ± 1.1 | 34.4 ± 1.6 | 37.7 ± 1.4 | 0.606 |
Waist circumference (cm) | 147 | 32.3 ± 1.9 | 32.4 ± 2.3 | 33.7 ± 2.6a
| 33.3 ± 1.9 | 0.014 |
Upper arm circumference (cm) | 191 | 10.9 ± 1.0 | 11.3 ± 1.4 | 11.3 ± 1.2 | 11.3 ± 1.2 | 0.214 |
Chest circumference (cm) | 161 | 33.0 ± 1.9 | 33.1 ± 2.7 | 34.4 ± 2.4a
| 33.5 ± 1.6 | 0.031 |
Hip-knee length (cm) | 188 | 11.0 ± 1.1 | 10.9 ± 1.1 | 10.8 ± 1.4 | 10.8 ± 1.2 | 0.916 |
Knee-heal length (cm) | 190 | 10.7 ± 1.1 | 10.8 ± 1.0 | 11.2 ± 1.1 | 11.2 ± 1.4 | 0.074 |
Admission to neonatal ward | 270 | 11 (9.2 %) | 0 (0 %) | 2 (4.3 %) | 2 (3.4 %) | 0.098 |
N
| Normal weight n ≤ 76
| Overweight or obese n ≤ 62
| Gestational diabetes n ≤ 45
|
P
| |
---|---|---|---|---|---|
Iron status | |||||
Ferritin (μg/l) | 119 | 168 (103–265) | 163 (115–233) | 139 (88–268) | 0.930 |
TS (%) | 49 | 60.7 ± 2.1 | 55.1 ± 17.7 | 64.3 ± 20.0 | 0.254 |
Hb (g/l) | 125 | 16.7 ± 1.6 | 17.0 ± 2.4 | 16.3 ± 2.1 | 0.359 |
MCV (fl) | 125 | 107.5 ± 5.4 | 107.0 ± 6.5 | 107.9 ± 3.7 | 0.776 |
Vitamins | |||||
Vitamin B12 (pg/ml) | 45 | 665 ± 512 | 436 ± 198 | 739 ± 333 | 0.005 |
Folate (ng/ml)b
| 150 | >20 (16.6– > 20) | 19.9 (15.5– > 20) | >20 (>20– > 20)a
| 0.010 |
Other biomarkers | |||||
Glucose (g/l) | 156 | 69.7 ± 21.1 | 66.2 ± 22.2 | 77.4 ± 22.4 | 0.050 |
Insulin (μU/ml) | 118 | 3.5 (2.2–5.8) | 4.4 (2.9–7.3) | 5.6 (2.0–10.3) | 0.126 |
HbA1c (%) | 34 | 3.2 (3.0–3.5) | 3.3 (3.2–3.5) | 3.7 (3.3–4.4) | 0.064 |
Uric acid (mg/dl) | 132 | 4.92 ± 0.90 | 4.95 ± 1.29 | 4.94 ± 1.06 | 0.995 |
Creatinine (mg/dl) | 131 | 0.60 ± 0.18 | 0.63 ± 0.23 | 0.61 ± 0.21 | 0.712 |
TSH (ng/ml) | 133 | 11.0 (7.3–15.3) | 8.4 (6.3–14.4) | 8.1 (5.5–12.2) | 0.270 |
CRP (mg/dl) | 47 | 0.00 (0.00–0.10) | 0.01 (0.00–0.03) | 0.01 (0.07–0.10) | 0.308 |
Cortisol (μg/dl) | 47 | 13.6 ± 4.5 | 13.7 ± 10.3 | 11.6 ± 5.7 | 0.678 |