Meeting paper
PCOGS papers
Intraabdominal fat, insulin sensitivity, and cardiovascular risk factors in postpartum women with a history of preeclampsia

Presented in oral format at the 83rd annual meeting of the Pacific Coast Obstetrical and Gynecological Society, Marana, AZ, Oct. 22-26, 2014.
https://doi.org/10.1016/j.ajog.2015.05.040Get rights and content

Objective

Women who develop preeclampsia have a higher risk of future cardiovascular disease and diabetes compared to women who have uncomplicated pregnancies. We hypothesized that women with prior preeclampsia would have increased visceral adiposity that would be a major determinant of their metabolic and cardiovascular risk factors.

Study Design

We compared intraabdominal fat (IAF) area, insulin sensitivity index (SI), fasting lipids, low-density lipoprotein relative flotation rate, and brachial artery flow-mediated dilatation in 49 women with prior preeclampsia and 22 controls who were at least 8 months postpartum and matched for age, parity, body mass index, and months postpartum. Women were eligible if they did not smoke tobacco, use hormonal contraception, have chronic hypertension, or have a history of gestational diabetes.

Results

The groups were similar for age (mean ± SD: prior preeclampsia 33.4 ± 6.6 vs control 34.6 ± 4.3 years), parity (median: 1 for both), body mass index (26.7 ± 5.9 vs 24.0 ± 7.3 kg/m2), and months postpartum (median [25th-75th percentile]: 16 [13-38] vs 16.5 [13-25]). There were no significant differences in IAF area and SI. Despite this, women with preeclampsia had lower high-density lipoprotein (46.0 ± 10.7 vs 51.3 ± 9.3 mg/dL; P < .05), smaller/denser low-density lipoprotein relative flotation rate (0.276 ± 0.022 vs 0.289 ± 0.016; P = .02), higher systolic (114.6 ± 10.9 vs 102.3 ± 7.5 mm Hg) and diastolic (67.6 ± 7.5 vs 60.9 ± 3.6 mm Hg; P < .001) blood pressures, and impaired flow-mediated dilatation (4.5 [2-6.7] vs 8.8 [4.5-9.1] percent change, P < .05) compared to controls. In a subgroup analysis, women with nonsevere preeclampsia (n = 17) had increased IAF (98.3 [60.1-122.2]) vs 63.1 [40.1-70.7] cm2; P = .02) and decreased SI (4.18 [2.43-5.25] vs 5.5 [3.9-8.3] × 10-5 min-1/pmol/L; P = .035) compared to the controls, whereas women with severe preeclampsia (n = 32) were not different for IAF and SI. IAF was negatively associated with SI and positively associated with cardiovascular risk factors even after adjusting for the matching variables and total body fat.

Conclusion

Women with prior preeclampsia have an atherogenic lipid profile and endothelial dysfunction compared to matched control subjects despite having similar adiposity and insulin sensitivity, suggesting that there are mechanisms separate from obesity and insulin resistance that lead to their cardiovascular risk factors. Visceral adiposity may have a role in contributing to these risk factors in the subgroup of women who have preeclampsia without severe features.

Section snippets

Study design

This was a cross-sectional study comparing body fat distribution, insulin sensitivity, β-cell function, fasting lipids, hepatic lipase activity, and endothelial function between postpartum women who had either an uncomplicated pregnancy (control group) or a history of preeclampsia (prior preeclampsia group). The study was approved by the University of Washington Institutional Review Board prior to initiation. All subjects provided written informed consent to participate.

Subjects

Subjects were recruited

Results

There were no differences between the groups in the matching variables, frequencies of exercise, or first-degree relatives with type 2 diabetes mellitus, obesity, hypertension, and cardiovascular disease (Table 1). The majority (65.3%) of the women in the prior preeclampsia group had severe features; 46.9% delivered <36 weeks’ gestation.

In contrast to our hypothesis, women with prior preeclampsia did not have greater adiposity as compared to the controls (Table 2). In linear regression models

Comment

In our study of healthy postpartum women who were matched for BMI, women with prior preeclampsia had higher blood pressures, an atherogenic lipoprotein phenotype, and endothelial dysfunction compared to women who had uncomplicated pregnancies. We anticipated that women with prior preeclampsia would also have greater visceral adiposity and be insulin resistant. Only women with nonsevere preeclampsia had increased visceral adiposity and decreased insulin sensitivity. Moreover, it was their

Acknowledgments

We thank the participants for their contributions to the research and the nursing staff of the General Clinical Research Center at the University of Washington for their care of the participants. We would like to acknowledge Dr Steven E. Kahn for being the primary mentor for the first author, Dr Darcy R. Barry. We are thoroughly grateful for his enthusiastic commitment to this work, his encouragement as a mentor, and his contributions as an expert in the area of glucose metabolism and the role

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    This work was supported by National Institutes of Health grant number K23 RR-016066 from the National Center for Research Resources, National Institutes of Health grant number K30 RR022293, a grant from GlaxoSmithKline (project number 49653-198), Clinical Nutrition Research Unit (DK-035816), Diabetes Research Center (DK-017047), and General Clinical Research Center (RR-000037) at the University of Washington, and the Medical Research Service of the Department of Veterans Affairs.

    The authors report no conflict of interest.

    Cite this article as: Barry DR, Utzschneider KM, Tong J, et al. Intraabdominal fat, insulin sensitivity, and cardiovascular risk factors in postpartum women with a history of preeclampsia. Am J Obstet Gynecol 2015;213:104.e1-11.

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