University of Oulu

Jemina Kivelä, Heidi Sormunen-Harju, Polina V Girchenko, Emilia Huvinen, Beata Stach-Lempinen, Eero Kajantie, Pia M Villa, Rebecca M Reynolds, Esa K Hämäläinen, Marius Lahti-Pulkkinen, Katja K Murtoniemi, Hannele Laivuori, Johan G Eriksson, Katri Räikkönen, Saila B Koivusalo, Longitudinal Metabolic Profiling of Maternal Obesity, Gestational Diabetes, and Hypertensive Pregnancy Disorders, The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 11, November 2021, Pages e4372–e4388,

Longitudinal metabolic profiling of maternal obesity, gestational diabetes, and hypertensive pregnancy disorders

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Author: Kivelä, Jemina1,2; Sormunen-Harju, Heidi2; Girchenko, Polina V.3;
Organizations: 1Department of Public Health, University of Helsinki, Helsinki, Finland
2Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
3Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
4Teratology Information Service, Emergency Medicine, Department of Prehospital Emergency Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
5Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland
6PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
7Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland
8Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
9Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
10Hyvinkää Hospital at Helsinki and Uusimaa Hospital District, Hyvinkää, Finland
11Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
12Department of Clinical Chemistry, University of Eastern Finland, Kuopio, Finland
13Finnish National Institute for Health and Welfare, Helsinki, Finland
14Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
15Department of Obstetrics and Gynaecology, University of Turku and Turku University Hospital, Turku, Finland
16Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
17Department of Obstetrics and Gynecology, Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
18Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore
19Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
20Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
21Folkhälsan Research Center, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.2 MB)
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Language: English
Published: Endocrine society, 2021
Publish Date: 2021-08-25


Context: Comprehensive assessment of metabolism in maternal obesity and pregnancy disorders can provide information about the shared maternal-fetal milieu and give insight into both maternal long-term health and intergenerational transmission of disease burden.

Objective: To assess levels, profiles, and change in the levels of metabolic measures during pregnancies complicated by obesity, gestational diabetes (GDM), or hypertensive disorders.

Design, Setting and Participant: A secondary analysis of 2 study cohorts, PREDO and RADIEL, including 741 pregnant women.

Main Outcome Measures: We assessed 225 metabolic measures by nuclear magnetic resonance in blood samples collected at median 13 [interquartile range (IQR) 12.4–13.7], 20 (IQR 19.3–23.0), and 28 (27.0–35.0) weeks of gestation.

Results: Across all 3 time points women with obesity [body mass index (BMI) ≥ 30kg/m²] in comparison to normal weight (BMI 18.5–24.99 kg/m²) had significantly higher levels of most very-low-density lipoprotein-related measures, many fatty and most amino acids, and more adverse metabolic profiles. The change in the levels of most metabolic measures during pregnancy was smaller in obese than in normal weight women. GDM, preeclampsia, and chronic hypertension were associated with metabolic alterations similar to obesity. The associations of obesity held after adjustment for GDM and hypertensive disorders, but many of the associations with GDM and hypertensive disorders were rendered nonsignificant after adjustment for BMI and the other pregnancy disorders.

Conclusions: This study shows that the pregnancy-related metabolic change is smaller in women with obesity, who display metabolic perturbations already in early pregnancy. Metabolic alterations of obesity and pregnancy disorders resembled each other suggesting a shared metabolic origin.

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Series: Journal of clinical endocrinology & metabolism
ISSN: 0021-972X
ISSN-E: 1945-7197
ISSN-L: 0021-972X
Volume: 106
Issue: 11
Pages: e4372 - e4388
DOI: 10.1210/clinem/dgab475
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: The PREDO project has been supported by EVO research funding (a special Finnish state subsidy for health science research), Academy of Finland, Signe and Ane Gyllenberg Foundation, Sigrid Juselius Foundation, University of Helsinki Research Funds, Finnish Medical Foundation, Juho Vainio Foundation, Novo Nordisk Foundation, Jane and Aatos Erkko Foundation, and Päivikki and Sakari Sohlberg Foundation. The RADIEL project has been supported by the Alfred Kordelin Foundation, Juho Vainio Foundation, Ahokas Foundation, the Finnish Foundation for Cardiovascular Disease, special state subsidy for health science research of Helsinki University Hospital (HUH), Samfundet Folkhälsan, Finska Läkaresällskapet, Viipuri Tuberculosis Foundation, The Finnish Diabetes Research Foundation. R.R. acknowledges the support of the British Heart Foundation (RE/18/5/34216).
Copyright information: © The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (, which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact