Energy expenditure in pregnant women with obesity does not support energy intake recommendations

J Most, PM Vallo, LA Gilmore, M St. Amant, DS Hsia… - …, 2018 - Wiley Online Library
J Most, PM Vallo, LA Gilmore, M St. Amant, DS Hsia, AD Altazan, RA Beyl, E Ravussin
Obesity, 2018Wiley Online Library
Objective This study aimed to identify factors that may predispose women to excess
gestational weight gain (GWG). Methods Seventy‐two healthy women with obesity (30 class
I, 24 class II, 18 class III) expecting a singleton pregnancy were studied at 13 to 16 weeks
gestation. Energy expenditure (EE) was measured during sleep (SleepEE, average EE from
0200‐0500 hours) in a whole‐room calorimeter, and total daily EE (TDEE) over 7 days using
doubly labeled water. Glucose, insulin, thyroid hormones, and catecholamines were …
Objective
This study aimed to identify factors that may predispose women to excess gestational weight gain (GWG).
Methods
Seventy‐two healthy women with obesity (30 class I, 24 class II, 18 class III) expecting a singleton pregnancy were studied at 13 to 16 weeks gestation. Energy expenditure (EE) was measured during sleep (SleepEE, average EE from 0200‐0500 hours) in a whole‐room calorimeter, and total daily EE (TDEE) over 7 days using doubly labeled water. Glucose, insulin, thyroid hormones, and catecholamines were measured.
Results
Body composition explained 70% variability in SleepEE, and SleepEE accounted for 67% to 73% of TDEE. Though there was no evidence of consistent low metabolism, there was considerable variability. Low SleepEE was associated with insulin resistance and low triiodothyronine concentrations (both P = 0.01). Physical activity level was 1.47 ± 0.02. For women with SleepEE within 100 kcal/d of their predicted EE, TDEE was significantly less than the estimate (2,530 ± 91 vs. 2,939 kcal/d; P < 0.001) provided from the most recent gestational energy requirement model.
Conclusions
Pregnant women with obesity are inactive, possibly predisposing them to excess GWG. Current energy requirement models overestimate activity and may promote excess GWG in women with obesity. Furthermore, the observed large interindividual variability in basal metabolism may be important to consider when assessing the risk for excess GWG.
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