Background/Aim:
Hypertensive disorders of pregnancy (HDP) impact 5-10% of women during pregnancy. Our six-months postpartum analysis of the metabolic parameters of women with HDP compared to their normotensive counterparts indicated a significant short-term relationship between preeclampsia and metabolic dysfunction. However, the short-to-medium impact on parameters including body composition, anthropometry and serum biochemistry remain relatively unclear. This study aims to determine whether (a) there are significant differences in insulin resistance, body composition and energy balance five-years after preeclampsia, gestational hypertension, and normotensive pregnancy (b) differences identified at six-months postpartum persist through to five-years.
Methods:
Metabolic sub-study conducted as part of the Postpartum Physiology, Psychology and Paediatric (P4) follow-up study. Five-years postpartum, women were assessed following preeclampsia, gestational hypertension (GH), and normotensive pregnancy (NP). Metabolic measurements included anthropometry and body composition via multi-frequency bioelectrical impedance analysis. Energy balance data were gathered using the SenseWear Armband (Model MF-SW, BodyMedia Inc.) to determine energy expenditure and a three-day food recall diary analysed using FoodWorks (Version 8, Xyris Software Aust. Pty Ltd., Australia) to determine total energy intake. Comparison of preeclampsia, GH and NP parameters five-years postpartum was performed using Chi-squared, independent-samples t-test, or Mann-Whitney-U as appropriate. Longitudinal data analysis at six-months, two-years, and five-years post-partum was performed using paired testing. A p-value <0.05 was considered statistically significant.
Results:
186 women were assessed: 139 after NP, 35 after preeclampsia, 12 following GH. GH women exhibited higher median weight (84.8kg) and BMI (29.2) than their normotensive counterparts (65.6kg, 24.4, p=0.001). The preeclamptic group had higher fasting insulin than the normotensive group (6.4µIU/mL versus 5.8µIU/mL) and higher HbA1c levels (6.0±4.4 versus 5.1±0.3%, p=0.02). The GH group had higher LDL-cholesterol levels than the normotensive group (2.7±0.7 versus 2.5±0.6mmol/L) and lower mean HDL-cholesterol (1.3±0.3 versus 1.6±0.4mmol/L, p=0.01). GH women exhibited higher waist circumference (105 versus 90cm), hip measurement (116 versus 102cm), relative fat-mass (43 versus 34%) and total fat-mass (38.7 versus 24.4kg), all p<0.05 compared to the normotensive group, while body composition differences between the preeclamptic and normotensive group were not significant. Energy balance was negative in all cohorts at five-years postpartum, however, findings were not statistically significant.
Conclusion:
Five-years following preeclampsia, women exhibited higher fasting insulin and HbA1c levels compared to their normotensive counterparts. Despite a relatively small sample size, GH women demonstrated significantly poorer metabolic outcomes compared to their normotensive counterparts. These results suggest persistent metabolic abnormalities following HDP, which may be amenable to early postpartum intervention.