Energy-sparing adaptations in human pregnancy assessed by whole-body calorimetry

The hypothesis that the energy cost of human pregnancy can be minimized by energy-sparing metabolic adaptations was tested using serial 24 h whole-body calorimetry. Eight healthy, well-nourished women were studied prepregnant and at 6, 12, 18, 24, 30 and 36 weeks gestation. Basal metabolic rate (BMR) showed highly characteristic changes within each subject and large inter-individual differences (F 3.5, P less than 0.01). Some subjects showed a highly significant depression of metabolism up to 24 weeks gestation in support of the initial hypothesis. At 36 weeks BMR ranged from +8.6 to +35.4% relative to the prepregnant baseline. This wide variability was not explained by differences in the amount of lean tissue gained. Women displaying the energy-sparing suppression of BMR tended to be thin, suggesting that changes in metabolism may be responsive to initial energy status (delta BMR v. prepregnant body fat: r 0.84, P less than 0.005). Changes in 24 h energy expenditure closely paralleled changes in BMR (r 0.98, P less than 0.001), since the energy cost of minor voluntary activity and thermogenesis remained very constant within each individual. Pregnancy decreased the net cost of weight-dependent and weight-independent standard exercises when expressed per kg body-weight: stepping -10 (SD 2)%, P less than 0.001 at 18-36 weeks, cycling -26 (SD 7)%, P less than 0.01 at 12-36 weeks. The average integrated maintenance costs of pregnancy matched previous group estimates from well-nourished women, but individual estimates ranged from -16 to +276 MJ (coefficient of variation 93%). This high level of variability has important implications for the prescription of incremental energy intakes during pregnancy. It may also have had evolutionary significance.