Background: Epidemiological evidence suggests an increased risk of cardiovascular associated diseases (CVAD) in both mother and offspring after pregnancies complicated by preeclampsia (PE) and diabetes mellitus (DM). The mechanisms behind this altered risk in health status are still scarcely unravelled. However, PE, DM and cardiovascular diseases (CVD) have several features in common, including shared risk factors and similar pathophysiology. Components of the metabolic syndrome and endothelial dysfunction, assumed to be closely related to nutritional intake and physical activity level, have gained increased attention as unifying mechanisms. Foetal programming in utero, as well as birth weight and growth pattern
in the early postnatal period, may also predict future disease risk. The knowledge regarding the relative contribution from intrauterine programming and nutritional and metabolic risk factors for the development of cardiovascular health and disease is limited, and is a subject for further research.
Objectives: In the present study we wanted to explore if there are any differences in lifestyle factors 5-8 years after delivery between women previously diagnosed with PE or DM in pregnancy and women without these complications, and likewise between their offspring. The lifestyle factors included in the master thesis were nutrition and physical activity. Also, associated risk factors for CVAD, including anthropometrics, blood pressure (BP), glucose levels and non-invasive measurements of endothelial function were evaluated.
Subjects: Women previously recruited to a caesarean section biobank in 2001-2004, 18 of which where diagnosed with PE, 14 of which had DM (8 gestational diabetes mellitus (GDM) and 6 DM1) and 9 subjects with uncomplicated pregnancies serving as a comparator group, agreed to participate in the present follow-up study, together with the child that was delivered and recruited to the original study in 2001-2004.
Methods: Height, weight, waist and hip circumferences, BP, endothelial function (non-invasive technique; EndoPAT) were measured in both mother and child. Both also delivered a urine sample (which was analysed with a urine stix to detect glucosuria or proteinuria), and venous blood samples were collected (for future analysis in other planned sub studies). An oral glucose challenge test (OGT) was
performed in the mother, with one reading in the fasting state at baseline and one reading 2 hours later after oral intake of 75 mg glucose in 300 ml water. Additional clinical information, as well as information regarding nutritional intake and physical activity level in both mother and child, were obtained from standardized questionnaires. The children also had a cardiac tissue Doppler ultrasound examination performed by a paediatrician, but the findings obtained from the Doppler study and the endothelial function assessment are not reported in the present master thesis (as the analyses will take another 6 months and exceed the scope of this master thesis).
Main outcomes/findings: In the CHASE follow-up study, a higher proportion of women and children in the DM-group were overweight and obese compared to the other groups. More women in the DM- and PE-group had abdominal obesity according to waist-to-hip ratio (WHR) measurements compared to the C-group. We also detected significant higher systolic BP and a lower physical activity level in women with previous PE or DM. Low intakes of vegetables were identified in all
groups. However, a larger proportion of children in the C-group followed the fruit dietary guidelines of two or more portions a day compared to the DM-group (p = 0.02) and the PE-group (p = 0.08) of children. Also, a non-significant larger proportion of the women in the C-group reported adhering to the fruit dietary guidelines compared to the two other groups of women. Women and children in the
C-group had a higher consumption of cod liver oil and lean milk types as compared to the other study groups.
Conclusion: Preliminary results of the CHASE clinical study have identified aims for potential intervention strategies in women and children after pregnancies complicated by PE, GDM or DM1. Such intervention could focus on maternal weight reduction and prevention of excessive weight gain in the children, increase in physical activity level among the women, and advice to increase the consumption of fruit/berries and vegetables, less sugar-sweetened beverages, promotion of lean milk types rather than higher fat milk types and possibly the use of cod liver oil supplements.
Key words: Preeclampsia (PE), diabetes mellitus (DM), gestational diabetes mellitus (GDM), cardiovascular disease (CVD), Cardiovascular associated diseases (CVAD) metabolic syndrome, endothelial dysfunction, foetal programming, nutrition, physical activity.