Changes in adipose tissue distribution during pregnancy in overweight and obese compared with normal weight women : a cluster-randomized controlled research study in Malta

Abstract

Background/Objectives: Pregnancy is accompanied by fat gaining and insulin resistance that is one of the most interesting researching topics in the past years. Changes in adipose tissue morphology and function during pregnancy and factors contributing to gestational insulin resistance are incompletely known. This research aims to assess the antenatal, intrapartum, postpartum complication differences in women with different categories in BMI as well to assess the antenatal, intrapartum, postpartum complication differences in fetuses born to women with different categories in BMI. Also, one of the most important objectives is to relate maternal and fetal outcomes to weight gain during pregnancy Subjects/Methods: This study was carried out in two different parts: A. A retrospective analysis of the national birth data collected by the Department of Health Information and Research [DHIR] as part of its ongoing National Obstetric Information System [NOIS] database. B. A prospective follow-up longitudinal assessment of a cohort of pregnant women. Results: This present study favorably compares with all the available epidemiologic studies that measure weight before and after the pregnancy in primiparas controlling for secular trends and aging that have consistently found that primiparity is associated with higher weight gain among women already overweight before pregnancy worldwide and in Malta. Statistical differences in the retrospective studies [P<0.05] were found in regard to: -Educational status -H/O Previous livebirth -H/O Previous miscarriages -Antenatal complications -Present mode of delivery -Infant birth weight Statistical differences in prospective studies [P<0.05] were found in regard to: -Educational status -H/O Previous livebirth -H/O Previous miscarriages -Antenatal complications -Present mode of delivery -Infant birth weight Conclusions: Comparing this study with all available epidemiologic studies that measure weight before and after the pregnancy in primiparas and that control for secular trends and aging have consistently found that primiparity is associated with higher weight gain among women already overweight before pregnancy worldwide and also in Malta. Women who are moderately overweight (25-29 kg/m2) before a first pregnancy may be advised to lose weight several months before planning pregnancy. Over-weight and obese women who have modest gestational weight gain, as well as average weight women who have excessive gestational weight gain, may benefit primarily from interventions during the postpartum period to promote weight loss and implement more physical activity than the women before and in that way to promote as well the benefits and risks of further complications.