Between Country Comparison of the Metabolic Costs of Pregnancy

The average costs across different populations result in a wide range of energy needs from — 30 MJ (-7000 kcal) to 523 MJ (125 000kcal). Studies found that the average costs in the well-nourished groups were similar to the current international assumption of 336MJ (80000kcal). These studies have also shown that the amount of prepregnancy body fat is strongly correlated with both the maintenance costs and the total metabolic costs of pregnancy. The combined costs of maintenance, fat deposition, and con-ceptus across studies from different countries drawn from emerging and affluent nations show that the energy cost of fat deposition also varies according to the state of affluence and is positively correlated with variations in maintenance requirements.

This flexibility in energy metabolism acts in a protective manner, with undernourished women showing significant energy-sparing adaptive strategies that tend to normalize energy balance. Body fat content is one of the measures of fitness for reproduction; fertility is suppressed in undernourished women. However, future unfavorable conditions cannot be anticipated and pre- or early pregnant fatness may be indicative of overall nutritional status and energy balance during pregnancy.

These relationships suggested the existence of a mechanism that can monitor the mother's prepreg-nancy energy status and adjust the homeorrhetic changes in maternal metabolism accordingly. The discovery of leptin provides a plausible mechanism by which peripheral energy status can be centrally monitored and may coordinate the metabolic responses to pregnancy. It is clear that in addition to its role in the regulation of adipose tissue, appetite, and metabolic rate, leptin plays a significant role in several components of the reproductive axis. Evidence suggests that it plays a key role in pregnancy, including the modulation of fetal growth.

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