title: Intraabdominal fat, insulin sensitivity, and cardiovascular risk factors in postpartum women with a history of preeclampsia.
abstract: 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.
  
  
  METHODS
  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/m(2)), 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] cm(2); 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA. Electronic address: darcyrbarry@gmail.com.
authors.forename: Darcy R
authors.initials: DR
authors.lastname: Barry
authors.affiliation: Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, Department of Veterans Affairs Puget Sound Health Care System, and University of Washington, University of Washington, Seattle, WA.
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Utzschneider
authors.affiliation: Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University, Durham, NC.
authors.forename: Jenny
authors.initials: J
authors.lastname: Tong
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
authors.forename: Kersten
authors.initials: K
authors.lastname: Gaba
authors.affiliation: Applied Physics Laboratory, University of Washington, Seattle, WA.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Leotta
authors.affiliation: Division of Metabolism, Endocrinology, and Nutrition, Seattle, WA.
authors.forename: John D
authors.initials: JD
authors.lastname: Brunzell
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Easterling
mesh_terms: D000328:Adult; D050218:Body Fat Distribution; D003430:Cross-Sectional Studies; D004730:Endothelium, Vascular / Q000502:physiology; D005260:Female; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D050152:Intra-Abdominal Fat; D049590:Postpartum Period / Q000502:physiology; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D014664:Vasodilation / Q000502:physiology
chemical_list: D005947:Glucose
keywords: body fat distribution; cardiovascular risk factors; endothelial dysfunction; insulin resistance; preeclampsia